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Reference Guide For 



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Child Abuse and Neglect 
— Investigations 



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Commonwealth of Massachusetts 
Michael S. Dukakis, Governor 
Philip W. Johnston, Secretary 
Executive Office of Human Services 

Department of Social Services 
150 Causeway Street 
Massachusetts 02114 
Marie A. Matava, Commissioner, 



/ 



ACKNOWLEDGEMENT 

The Massachusetts Department of Social Services wishes to express its 
appreciation to the Illinois Department of Children and Family Services. 
Both their commitment to child protective services and their investigative 
handbook provided the framework for this Reference Guide. 



First Edition, 1984 
Second Edition, 1988 



PREFACE 



by MARIE A. MATAVA, COMMISSIONER 
MASSACHUSETTS DEPARTMENT OF SOCIAL SERVICES 



The development of this Reference Guide has been a combined effort that 
has utilized the product of the Illinois Department of Children and Family 
Services, as well as the energies of central, regional, and area Department 
of Social Services staff. It is the Department 's hope that this Reference 
Guide serves the purpose that its title implies; that is, a source that 
social workers can use to seek information regSrding interviewing techniques, 
decision making, legal issues, and case recording. Its use, in conjunction 
with existing statutes, regulations, and training programs, will enhance the 
protective casework services provided by the Department. 



STATEMENT OF PHILOSOPHY 

The policy of the Commonwealth of Massachusetts, and therefore of the 
Department of Social Services, is to strengthen and encourage family life so 
that every family can care for and protect its children. To that end, the 
Department will make every reasonable effort to encourage and assist families 
to use all available resources to maintain the family unit intact. However, 
for so long as a family cannot or does not provide the necessary amount of 
care and protection for its children, the Department will intervene to protect 
the right of children to sound health and normal physical and mental develop- 
ment. These dual obligations — to protect children and yet simultaneoulsy 
to respect the right of families to be free from unwarranted state interven- 
tion — present an inherently difficult balance to strike. Yet, this is 
precisely the Department 's mandate. The effort to balance these two basic 
obligations, above all others, shall govern the Department's activities 
(see Department Regulation 110 CMR 1.01). 



I. INVESTIGATIVE TECHNIQUES 

Page 

A. DEVELOPING AN INVESTIGATIVE PLAN J 

1. Reviewing The Report 2 

2. Agency Records Check J 

3. Circumstances In Which Law Enforcement Assistance 

Is Considered 3 

4. Locating Subjects 3 

5. Techniques For Obtaining Information 3 

B. INTERVIEWING TECHNIQUES .... 4 

1. Objectives Of Interviewing ... 4 

2. Preparing For Interviews 4 

3. Interviewing Subjects And Collaterals 5 

4. Entry Techniques 5 

5. Establishing Rapport 6 

6. Maintaining Control 7 

a. Structuring 8 

b. Maintaining Objectivity 8 

c. Being Assertive 8 

d. Anticipating Responses and Questions 8 

e. Discontinuing 8 

f. Responding to Compliant Interviewees 9 

g. Handling Physical /Verbal Threats 9 

7. Influence Of Interviewee's Condition 11 

8. Techniques For Interviewing Adults 12 

a. Language Usage 12 

b. Full Expression of Ideas /Feelings 13 

c. Reenactment of The Incident 13 

d. Discrepancies in Information 13 

e. Candor 14 

f. Behavioral Manifestations 14 

g. Silence ■ 14 

9. Techniques For Interviewing Children 14 

a. Caretaker's Cooperation 16 

b. Individual Interviews 16 

c. Impact on Caretaker-Child Relationship 16 

d. Play as an Interview Technique 17 

e. Developmental Considerations 17 

f. Play Equipment 17 

g. Physical Environment 18 

h. Conducting the Interview 18 

i. Communication Techniques 19 

j. Self-Blame 19 

k. Clarity 19 

1. Time Considerations 20 

m. Child's Input Into Interview 20 

10. Techniques For Interviewing The Reporter 20 

11. Techniques For Interviewing Collateral Sources 21 

12. Techniques For Closing Interviews 22 



Page 

C. OBSERVATION TECHNIQUES 22 

1. Physical /Medical Indicators 24 

2. Behavioral Indicators . 26 

3. Developmental Milestones 26 

4. Caretaker's Attitude Towards The Child And 

The Parenting Exoerience 26 

5. Family Functioning 28 

6. Environmental - Physical Conditions In Home 30 

7. Ecological - Physical Conditions Of Surrounding 

Neighborhood 31 

8. Cultural Biases And. Influences 31 

D. TECHNIQUES TO OBTAIN DOCUMENTS /PHYSICAL EVIDENCE 33 

1. Medical Examinations 34 

2. Mental Health Evaluations 34 

3. Written Documentation 35 

4. X-Rays 35 

5. Record Availability 35 

E. ACTIONS TAKEN DURING THE INVESTIGATION 36 

1. Emergency Intervention 36 

a. Maintaining The Child With The Family 36 

b. Temporary Protective Custody 36 

2. Providing Feedback To Caretaker And Child 37 

3. Providing Feedback To Reporter 37 

4. Notifying Central Registry Of Investigative Findings 37 

5. Effecting An Investigative Disposition 37 



II. DECISION MAKING 

A. INTRODUCTION 40 

B. CHAPTER OVERVIEW 41 

C. DECISION-MAKING PROCESS 42 

1. Identifying And Defining Investigative 

Decision Questions 42 

2. Determining What Informations Is Necessary 

To Answer Decision Questions 43 

3. Gathering Evidence 44 

4. Cross-Checking And Validating Evidence 44 

5. Comparing Evidence To Decision Specific Factors 46 

6. Consultation 46 

7. Summary 46 

D. ASSESSMENT OF RISK 49 

1. Child Factors 50 

a. Age 50 

b. Physical and Mental Abilities 52 



Page 

2. Caretaker Factors 53 

■ a. Level of Cooperation 53 

b. Physical, Intellectual and Emotional Abilities/ 

Self-Control 54 

3. Alleged Perpetrator Factors 56 

a. Rationality of Behavior 56 

b. Access to the Child 57 

4. Incident Factors . 58 

a. Extent of Permanent Harm . 58 

b. Location of the Injury 59 

c. Previous History of Child Abuse or Neglect 60 

d. Physical Conditions of the Home 61 

5. Environmental Factors 62 

a. Support Systems 62 

b. Stress 64 

6. Factor Matrix 65 

7. Summary 68 

E. INVESTIGATIVE DECISIONS 69 

1. Emergency Response 69 

a. Location of the Child 70 

b. Existence of Major Family Crisis 70 

c. All Major Actors in One Location 70 

2. Emergency Services . . . 70 

3. Investigative Plan 71 

a. Information Required 72 

b. Location of Information 72 

c. Sequence of Interviews 72 

d. Location of Interview 72 

e. Techniques of Information Collection 72 

4. Police Involvement 73 

5. Investigation Completeness 73 

6. Reasonable Cause 73 

7. Summary 79 



III. EVIDENCE 



A. INTRODUCTION 80 

B. TYPES OF EVIDENCE 80 

1. Direct Evidence 80 

2. Demonstrative Evidence 80 

3. Circumstantial Evidence 81 

4. Expert Evidence 81 

C. ADMISSIBILITY OF EVIDENCE 81 

1. Relevant Evidence 81 

2. Prejudicial Evidence 82 

3. Objections 82 



Page 

D. HEARSAY 82 

1. Rationale For The Hearsay Rule 82 

2. ExceDtions To The Hearsay Rule 83 

a. Admissions by a Party 83 

b. Excited Utterances 83 

c. Statements Showing State of Mind 83 

d. Statements of Present Physical Sensations 84 

e. Business Records 84 

E. USE OF DOCUMENTS AND TANGIBLE EVIDENCE 84 

1. Photographs 85 

2. X-Rays 85 

3. Medical Records 85 

4. Miscellanecus Records 85 

5. Obtaining Documents And Other Evidence 85 

a. Consent 86 

b. The Case Record 86 



IV. RECORDING INFORMATION 



A. INTRODUCTION 87 

3. DOCUMENTATION SKILLS 87 

1. Thoroughness 88 

2. Accuracy 88 

3. Clarity 88 

a. Organization 88 

b. Precision 89 

c. Brevity 89 

4. Timeliness 89 

5. Seoarating Facts From Judgments 90 

6. Who, What, When, Where, How Questions 90 

a. Who Questions 90 

b. What Questions 91 

c. When Questions 91 

d. Where Questions 91 

e. How Questions 92 



V. CONCLUSION/SUhMARY 

A. INTRODUCTION 93 

B. RECEIPT OF A REPORT 93 

C. DEFINING THE PARAMETERS OF INVESTIGATION 93 



Page 

D. INVESTIGATIVE TECHNIQUES: OBSERVE, INTERVIEW, 

GATHER EVIDENCE 94 

E. DOCUMENTATION 94 

F. WEIGHING EVIDENCE 95 

G. DECISION MAKING . 95 

1. Risk Assessment 95 

2. Investigation Decision 96 

H. PROTECTING THE CHILD 96 



APPENDICES 



APPENDIX A 
APPENDIX B 
APPENDIX C 
APPENDIX D 
APPENDIX E 



GLOSSARY OF TERMS 



ABUSE AND NEGLECT DEFINITIONS 



PHYSICAL AND MEDICAL INDICATORS OF CHILD ABUSE AND NEGLECT 
BEHAVIORAL INDICATORS OF ABUSE AND NEGLECT 
DEVELOPMENTAL MILESTONES OF CHILDREN 



INTRODUCTION 



This Reference Guide for Child Abuse and Neglect Investigations espouses a 
specific philosophy of and a corresponding approach to protection of children. 
It focuses on protection of the child and the coordination and mobilization of 
DSS programs and services to assure the best interests of the child are served. 
The child is of primary importance in investigations of allegations of abuse and 
neglect. Accordingly, the investigation is narrowly defined as a fact finding 
mission rather than a service delivery program. Nonetheless, the family's needs 
are not ignored during the investigative phase. A significant percent of the 
reports received by the Department are subsequently not supported. In a 
number of instances, therefore, the only family crisis which exists is that 
created by the Department's intervention. In order to minimize the impact on 
the family, investigations are conducted as expeditiously as possible. If the 
reoort is not supported, the social worker may inform the family of optional 
services offered by the Department to meet family needs other than those focused 
on protecting the child. 

The Department also strives to increase the cooperation of external professionals 
and agencies in order to: 

improve the quality of investigative evidence gathered 

reduce duplicative actions (repeated interviews or physical examina- 
tions, for example) 

improve the quality of decisions made through consultation with multi- 
disciplinary professionals. 

The overriding purpose of this Reference Guide is to provide information and 
techniques to assist the social worker in protecting children from harm. 
Accordingly, it serves as a reference source which: 

details specific investigative techniques (interviewing, observation, 
documentation of evidence, and decision making) to complete the 
investigation 

assists in assuring statewide consistency in the performance of investi- 
gations and the resultant decisions 

It is not designed to impart skills such as interviewing or observing. Rather, 
it provides the basic concepts which should be used to refresh one's memory 
prior to conducting a specific investigative function. It also provides 
techniques and sources of information pertinent to difficult situations, e.g., 
threats, locating subjects, etc. 

It is formatted and organized to provide ready access to information and techni- 
ques. The chapters are organized by general topics as follows: 

I. Investigative Techniques 

II. Decision Making 

III. Evidence 

IV. Recording Information 

V. Conclusion /Summary 



CHAPTER I 
INVESTIGATIVE TECHNIQUES 



I. INVESTIGATIVE TECHNIQUES 



The Department of Social Services is mandated by statute to receive and investi^ 
gate allegations of abuse and neglect of children. 

The investigation is a fact-finding process which is designed to determine if 
there is reasonable cause to believe that abuse or neglect exists. Reasonable 
cause means a basis for judgement that rests on specific facts, either directly 
observed or obtained from reliable sources, and that supports a belief that a 
oarticular event probably took place or a particular condition probably exists. 

To support a report means that the Department has reasonable cause to believe 
that an incident (reported or discovered during the investigation ) of abuse or 
neglect by a caretaker did occur. To unsupport a report means that the 
Department has no reasonable cause to believe that an incident of abuse or 
neglect by a caretaker did occur. 

Investigations are designed: 

to orotect the health and safety of child(ren) 

to ascertain all facts pertinent to the allegations of abuse and neglect 
while minimizing the Department 's interventipn in the family, and 

to determine if there is reasonable cause to believe that abuse or 
neglect exists 

This chapter delineates the factual information and investigative techniques 
workers need to complete child protective investigatipns. In addition, this 
chapter highlights techniques which workers should use to conduct the 
investigation. 

It is organized under five major subsections: Developing an Investigative 
Plan, Interviewing Techniques, Observation Techniques, Techniques to Obtain 
Documents /Physical Evidence, and Actions Taken During the Investigation. 

A. DEVELOPING AN INVESTIGATIVE PLAN - (Pre-Visit Planning) 

Developing an investigative plan is the first task completed by the worker 
in the investigation of reports of abuse and neglect. In completing this 
task, the worker: 

reviews the report 

checks the Department requirements and investigative timeframes 

completes an agency data check, including ASSIST, current and former 
workers 

considers /obtains law enforcement assistance, if applicable 



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locates the subjects of the report 

plans interviews with family and collateral sources 

1. Reviewing The Report Of Suspected Child Abuse And/Or Neglect 

The worker begins the investigatory process through review of the 
allegations and information contained in the report and any other 
information noted by the screener. The worker should also contact the 
reporter, if possible, to clarify any information included in the 
report, and/or to gather further information. 

After this review, the worker is prepared to make decisions regarding 
the type and number of interviews that will be needed to complete the 
investigation. The allegations will suggest appropriate persons to be 
interviewed in addition to the subjects of the report. For example, 
the worker might plan to interview the child/family's treating physician 
when a report alleges medical neglect. Similarly, the severity of harm 
indicated in the report will determine what other referrals may be 
necessary. 

It is important to have as much information as possible prior to 
interviewing the child and caretaker in order to formulate appropriate 
questions and/or strategies for questioning. Because of the multi- 
plicity of factors affecting child rearing and the varied conditions 
and situations which contribute to harm, the worker will be best pre- 
pared to pursue a comprehensive investigation if the line of questioning 
can be narrowed to those areas most relevant to the allegations. For 
example, although at times an important consideration, the issue of 
the regularity of the child's school attendance will not be of prime 
concern when the report specifies that the child has a subdural 
hematoma. 

An early decision made by the worker is whether to make an unannounced 
visit with the family or to schedule an appointment. Among the factors 
to be considered are: 

immediate safety of child 

investigative timeframes 

In selecting the best time to interview, the worker should also con- 
sider whether the caretaker works, and if so, his work schedule. 

The worker will need to develop a strategy for conducting interviews 
with the child, caretaker(s), and key members of the household /family. 
Children, caretakers and significant others should be interviewed alone 
initially in order to obtain their version of the story. Subsequently, 
the worker may interview the caretakers together and then the child 
with the caretakers. The purpose of the latter interviews will be to 
observe the interactions of the family members and to note any changes 
in the information provided to the worker. 



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2. Agency Records Check 

The worker should complete a check of the agency ASSIST system prior to 
the onset of the investigation. If a report originates in the local 
area office, the worker's checking with ASSIST can identify if the 
family is currently receiving services or is previously known to the 
Department. 

A complete check must be made of all pertinent Department records by 
ASSIST prior to making a determination of the validity of the report 
allegations. The purpose of this check is to ascertain whether the 
Department had any previous contact with the adult or child subjects 
of the report. Aliases and spelling variations should be considered 
when undertaking the record check. The possibility that a name has 
been misspelled or the first name/last name inverted must be considered. 
For example, Allen Peter may in fact be listed and filed as Peter Allen. 

As a final step, the social worker may consult with other DSS staff who 
have conducted previous investigations or have provided services to the 
family. These workers may have important information about the family 
that will assist the social worker in planning and carrying out the 
investigation. 

J. Circumstances In Which Law Enforcement Assistance May Be Considered* 

Notification of the police is necessary to preserve the peace, e.g., 
the ,report states there are weapons in the home, and the alleged 
offender has a history of violence. 

The physical environment of the home possesses an immediate threat 
to the child. 

The evidence suggests that parental anger and discomfort with the 
investigation will be directed toward the child in the form of 
severe retaliation against him or the worker. 

4. Locating The Subjects Of The Report 

In the majority of investigations, the worker will be able to locate 
the subjects of the report with the information provided by the 
reporter. On occasion, however, additional effort may be needed. 

A variety of additional sources can potentially provide information 
about the whereabouts of the subjects of a report. It should be under- 
stood that these sources may require written authorization in order to 
release this information. 

5. Techniques For Obtaining Investigatory Information 

As Dreviously discussed, the worker relies on three major techniques 
for obtaining information needed to support or unsupport a report of 
abuse or neglect. These include interviewing, observation, and obtaining 
documents /evidence . The best method for obtaining inforation is through 
in-Derson contacts. Many people are hesitant to share private infor- 
mation over the phone. Through in-person contacts, the worker identi- 
fies/confirms his affiliation with the agency. Personal contact: 

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facilitates interviews 

underscores the importance of the investigation 

increases the chance that the interviewee will share the requested 
information 

provides opportunities for gathering information through observation. 

B. INTERVIEWING TECHNIQUES 

Interviewing is the primary tool used by workers to gather information to 
complete investigations. Workers must be knowledgable about interviewing 
techniques and objectives in order to complete investigations in a timely 
and comprehensive manner. 

1. Objectives Of Interviewing 

The purpose of interviewing is to establish contact with the subjects 
of the report and other persons who may have relevant information. The 
worker should use investigative interviews to secure facts relevant to 
determining whether a child has been harmed or is in risk of future 
harm, and to determine whether or not there is reasonable cause to 
believe that abuse and /or neglect exists. 

2. Preparing For Interviews 

In preparing to conduct a child abuse/neglect investigation, the worker 
must consider and resolve any residual feelings he may have about his 
authority to conduct investigations. It is also critical for the 
worker to evaluate his own reactions to the allegations contained in 
each report. Workers, despite their training and expertise, are not 
completely immune from negative feelings about the allegations. The 
worker must be prepared to acknowledge and respond to his own biases, 
positive or negative, in order to complete an objective assessment 
of the facts. 

Workers also need to be aware that some allegations of abuse and neglect 
will not be settled conclusively. Despite rigorous investigative 
efforts, the evidence will not prove or disprove certain allegations. 
Consequently, workers will be faced with the decision to support 
or unsupport reports without the comfort of knowing that the available 
information is conclusive. 

Finally, the worker must contemplate the possible risk to his own 
physical safety in carrying out the investigation. Police assistance 
may be utilized when there is concern for the personal safety of the 
social worker. 



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J. Interviewing The Subjects Of The Report And Collateral Contacts 

The rule of thumb for the investigation is that obtaining too much 
information is preferred to obtaining too little. Remembering that 
each piece of information is the key to additional information 
reinforces the importance of the fact-finding process and the 
. interviewing mode. 

At a minimum, the child must be viewed. Other siblings, because of 
their potential maltreatment and their key vantage point as observers 
of and participants in family interactions, are an important part of 
the interview process as are other family members and household 
residents. These individuals often have first-hand knowledge which 
can be invaluable to 'the conduct of a comprehensive investigation. 
The extent and nature of these interviews will be determined by the 
circumstances of each individual report. When interviewing siblings, 
several factors should be considered. Siblings should never be told 
which child was identified as the victim on the report received by 
the Department. 

Caution should be used when discussing specific allegations with any 
of the children. If the identified child's siblings appear to be 
physically abused or neglected, the worker should include them in 
the investigation and the worker should physically examine these 
siblings if their appearance or their statements so warrant. (Please 
refer to pages 23 and 24 of this manual for further information on con- 
ducting physical examinations of children). 

The worker's questioning should be guided by a desire to be able to 
answer with specific factual information all who, what, where, when, 
and how questions that arise from the allegations. 

4. Entry Techniques /Opening The Interview 

The manner in which the- worker begins the initial interview sets the 
tone and pace for the investigation. Consequently, it is important 
that the worker utilizes techniques which will facilitate entry 
into the home. 

The worker should introduce himself to the caretaker as a representa- 
tive of the Department. He should then state the purpose of and 
authority for this visit. The worker should anticipate that the 
individual will be, at the minimum, surprised at the worker's 
presence. The worker should be prepared to show his Departmental 
identification card. Before beginning a lengthy conversation, the 
worker should ask permission to enter the house if the caretaker has 
not already extended this invitation. Once inside, the worker should 
try to direct them to a comfortable private area to sit down and talk. 

The worker should then state the reason for the investigation, making 
reference to the receipt of a report by the Department. Leading 
into the interview by discussing the agency's concern for the child's 
safety and well-being, in general terms rather than in specific 
terms, will encourage the caretaker's discussion of his problems and 
will not limit the conversation by focusing exclusively on the 
specific allegations in the report. The worker should assume a non- 
accusatory manner and emphasize that the report has not been accepted 



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as true and that determining its validity is the purpose of the fact- 
finding process. In addition, the worker should enlist the caretaker's 
assistance in identifying problems and in determining whether the 
child has been harmed or is in risk of future harm. The worker 
should consider asking the caretaker about the child in general, e.g., 
■ his routine, behavior, development, to ease into a more specific 
discussion of the caretaker-child interactions and the caretaker's 
perception of the child's condition. 

If the individual refuses the worker entry into the home, the worker 
may wish to contact him later the same day to see if he is willing to 
allow entry. If the individual continues to refuse the worker's 
entry, the worker should consult with his supervisor. 

Additional information which should be shared with the caretaker 
before the close of the initial interview includes: 

the agency's responsibility to secure information from other 
persons and facilities in order to complete a thorough 
investigation 

the agency's responsibility to intervene when necessary, 
including taking protective custody, initiating court 
petitions, and providing services 

the agency's intent to work confidentially with them 

the fact that information concerning the report has been 
entered into the agency's files 

the additional action to be taken by the worker, including 
information that will be sought; whenever possible, the 
worker should try to obtain a written consent /release of 
information from the' parent 

5. Establishing Rapport 

Interviews provide opportunities for the social worker to explain the 
agency's concern for the safety and well-being of children and its capa- 
city and responsibility to help caretakers insure the child's future 
safety. Workers use a variety of methods to establish rapport. These 
methods vary significantly given the persons involved and the situa- 
tion in which interviews are taking place. Workers exercise their 
professional judgement when formulating an approach to developing 
rapport and take into consideration several factors, including: 

the emotional and physical health of the individual 

the apparent educational level of the individual 

the individual's ability to understand English or the worker's 
fluency in the interviewee's language 

the maturity and sophistication of the individual 

the individual's level of hostility 



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Investigative interviews are usually conducted in person, although 
telephone contacts with collateral sources are used when time and other 
constraints make face-to-face contact impossible. Interviews with the 
caretaker and child must always take place in person, although sub- 
sequent telephone contacts may be used to obtain clarifying information 
or to discuss a particular aspect of the agency's intervention. 

The nature of the investigation and intervention in family life may 
create an adversary relationship between the worker and the family. 
The worker must be mindful that attempts to discuss problems and 
concerns with the family may be difficult and may be met with some 
resistance. Communication can only be accomplished if the worker is 
willing and able to discuss the nature and potential outcomes of the 
agency's involvement. Persons who feel that they are being deceived 
or manipulated will be hesitant to talk openly about child rearing 
difficulties that may have resulted in abuse and neglect. The worker 
should never lie to or deceive the caretaker or child. Attempts to 
soften the impact of the agency's involvement, through hidden agendas 
or by misrepresenting the process or outcome of child protective inter- 
ventions to assure the child's safety, will backfire. Rather, the 
worker should emphasize that the agency's primary objectives are to 
assure the child's safety, to determine the validity of the report, and 
to limit its intervention in family life. Expressing the agency's child 
protective role and responsibility in a nonthreatening, nonaccusatory, 
matter-of-fact manner will convey concern for the child's safety and the 
non-compromising nature of the investigation. In addition to discussing 
agency's intervention, the worker must provide the caretaker with a copy 
of the letter which explains the reason for the Department 's interven- 
tion and information about the individual's rights as a DSS consumer. 

6. Maintaining Control During Interviews 

The potential adversary nature of child protective investigations may 
create a difficult environment for conducting interviews. Caretakers 
may express anger, hostility, denial, or resistance. They may do so by 
becoming verbally abusive, sullen, manipulative, overly compliant and/ 
or physically aggressive. In order to maintain control during inter- 
viewing, the worker utilizes a variety of techniques, including: 

structuring interviews 

maintaining objectivity 

being assertive 

anticipating responses and questions 

discontinuing interviews temporarily 

responding to overly compliant interviews 

handling physical /verbal threats 



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a. Structuring Interviews 

To control the interview, workers should keep interviewees on the 
subject, limit their going into excessing /extraneous detail, and 
control the range of reactions that interviewees exhibit. The 
worker should not act shocked or surprised at information given or 
feelings expressed during child protective service investigations. 

b. Maintaining Objectivity 

In order to tolerate the expression of negative feelings, the worker 
must not interpret them as a personal attack. Failure to do so will 
result in the worker becoming defensive, discourteous, agrumenta- 
tive, or conciliatory and is likely to disrupt the course of the 
interview. Be aware that retracting from your position, apologiz- 
ing for the investigation, and/or inappropriately agreeing with the 
caretaker's statements to pacify him will weaken your authority 
as well as complicate and impede the interview. 

c. Being Assertive 

The worker should be assertive by communicating confidence in his 
own role and his professional judgement. He must demonstrate 
acceptance of the responsibilities invested in him by state law, 
agency policy and procedure, and be comfortable with his knowledge 
and expertise as a child protective investigator. He should not 
express fear, embarassment or discomfort with his role as the 
agency's representative. Nonetheless, the worker must convey the 
authority of the agecy without appearing authoritarian. Remaining 
calm, composed and attentative rather than excited, aloof, 
insensitive or belligerent is important. 

d. Anticipating Responses and Questions 

The worker should anticipate that the subjects of child protective 
investigations may want to know the identity of the reporter and may 
become hostile or antagonistic in an effort to obtain this informa- 
tion. The release of any information regarding the identity of a 
reporter must be consistent with current statutes and regulations. 
The worker should redirect the interview, making it clear that the 
investigation must continue. In some instances, it is inevitable 
that the caretaker will name the reporter as he engages in a 
guessing game to determine the reporter's identity. The most 
effective way to deal with this is to expect that it will happen 
and to be prepared to matter -of -f act ly redirect the interview back 
to the incident each time it occurs. 

e. Discontinuing Interviewing Temporarily 

A final strategy that should be considered when the caretaker's 
anger or hostility is hampering the investigation is to stop the 
interview temporarily and resume it at a later time. Before the 
worker selects this technique he must fully consider the following: 



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the effect the pause may have on the child's safety 

the possibility that the caretaker might try to cover up the 
truth 

the likelihood that the family might flee with the child 

the timeframes for completing the investigation 

The worker should consider interviewing the child or other family/ 
household members when it appears necessary to temporarily dis- 
continue the interview with the caretaker. Unless physically 
threatened, the worker must see the child prior to leaving the 
home. Pausing to do so gives the worker an opportunity to carry out 
mandated responsibilities while providing the caretaker with time 
to calm down and regain his composure. 

f. Responding to Overly Compliant Interviewees 

Workers may encounter interviewees who are unable to express them- 
selves directly and behave in what superficially appears to be a 
very socially acceptable manner. The worker who is not prepared to 
deal with the overly compliant, accepting, and /or helpful caretaker 
may relinquish control of the interview as would a worker who is 
intimidated by the aggressive caretaker. 

The worker should not be falsely assured by overly compliant, 
cooperative and accommodating behavior or statements. This may be 
a smoke screen to diffuse the agency's concern and to manipulate 
the worker. The worker should be suspicious when, despite the 
adversary nature of the investigation, the caretaker graciously and 
warmly receives you into the home, taking care to be friendly and 
complimentary during the interview. This may be coupled with 
attempts by the interviewee to engage in social conversation. 
While acknowledging to the interviewee that this behavior and 
attitude is facilitating the interview, the worker should emphasize 
that determining the validity of the report is the main purpose 
of the investigation. 

g. Handling Physical /Verbal Threats 

On occasion, workers will encounter caretakers who threaten the 
worker's physical safety. No threat should ever be ignored , 
although the context and expression of it will influence the 
worker's response. Observations about the interviewee's behavior, 
communication and physical appearance are also critical to gaging the 
likelihood that the individual will carry out a threat or physically 
attack a worker. These cues include: 

The interviewee who is experiencing a high degree of emotional 
arousal, e.g., feeling rage or threatened, may exhibit an 
increase in body movement, an acceleration in speech, and a 
change in the volume and tone of voice. 



-9- 



An individual who is feeling under attack or that his territory 
is being invaded may physically distance himself from the 
worker in an effort to defend himself from the perceived threat. 

The interviewee's facial expressions - tensed muscles, dilated 
pupils/ fixed stare, clenched teeth, reddened face -signal anger 
that may become uncontrolled. 

Communications which become abbreviated during the course of 
the interview may signal the individual's loss of control. 
Noteworthy is a change from narrative explanations and answers 
to abrupt, abbreviated speech, e.g., yes, no, so what, leave, 
etc. 

Establish direct eye contact with all interviewees; however, 
staring or glaring can be as distracting as failing to look 
directly at the interviewee. 

Be attuned to the impact of physical proximity on an interview. 
The greater the physical distance between the worker and inter- 
viewee, the more difficult it is for the worker to communicate 
a helping attitude. Conversely, sitting or standing too close 
to the interviewee may be so distracting and discomforting that 
it impedes the interview. 

Consider the effect of your body posture on the interview 

process. Face the interviewee fully and squarely, incline your 
body forward, and be able to move toward the other person. 

Be attuned to the effective use of nonverbal gestures . A 
spontaneous use of* nonverbal gestures, e.g., head nods, hand 
movements, can enhance communication; however, the overuse of 
these can be distracting. 

In order to encourage interviewees to openly and candidly discuss 
problems and concerns, the worker may utilize the following 
techniques: 

Use unstructured invitation-to-talk statements that enable or 
encourage the interviewee to begin talking about her concern. 
For example, "Can you tell me how John hurt himself?" 

Minimal verbal responses from the worker, e.g., yes, no, um-hum, 
sure, reinforce the interviewee's effort to talk about the 
issue and concerns, while reflecting the worker's attentiveness 
and interest. 

Probes are responses or questions that require more than the 
minimal yes /no closed ended responses. Probes are generally 
prefaced by "what," "where,", "when," or "how." For example, 
rather than asking "Did you beat John and make those marks?" 
the worker could ask, "How do you discipline John?" 



-10- 



° Use restatements to let the interviewee know that you were 
listening attentively and that you understood what was said. 
Restatements may include all or a selected portion of a 
interviewee's remarks. In addition, restatements provide the 
interviewee with an opportunity to correct the worker's 
perception of what was said but misunderstood. You can also 
ask the interviewee to restate all or part of an answer for 
clarity. 

Periodically summarize the content and central feelings 

expressed by the interviewee to demonstrate your attentiveness 
and interest. 

Repeat information when it is not evident that the interviewee 
has heard or understood the first time. Repetition should also 
be used when it is important to emphasize certain points. 

7. Influence Of The Interviewee's Condition On The Interview Process 

An important factor influencing the process and outcome of any interview 
is the condition of the person being interviewed, which include: 

the individual's age 

the individual's level of intellectual functioning 

the personality of the individual 

the emotional state of the individual 

the influence of alcohol or other chemical intoxicants 

any handicap or physical disability 

As a general rule, do not attempt to conduct interviews with chemically 
intoxicated individuals. In all but emergencies, these interviews 
should be postponed. If the caretaker's functioning is so hampered by 
his condition that it endangers the child's safety, consider emergency 
intervention. 

In all other situations, the worker should inform the individual that 
you will return in a few hours or the next day to resume the interview. 
If discussion with the intoxicated person cannot be postponed, the 
worker will find that patience is absolutely necessary. Keep questions 
simple and focused in on the situation at hand. Consider the need for 
leaving a note to remind the individual of your expected return. Before 
leaving, the worker must see the child who is the subject of the report. 
If the caretaker won't permit access to the child, the worker must 
immediately notify his/her supervisor. Additionally, the worker will 
need to know what arrangements have been made for the child's care and 
supervision. 



-11- 



8. Techniques For Interviewing Adults 

Investigative interviews provide workers with opportunities to secure 
facts relevant to determining whether a child has been harmed or is at 
risk of future harm and to determine if there is reasonable cause to 
believe that abuse and neglect exists. Interviews are conducted with 
the subjects of the report, witnesses and other collateral contacts. 
The techniques utilized by workers as they interview adults will vary 
given the educational level, maturity, emotional state, condition and 
exDertise of the interviewee. Because of the differences, interviews 
will collateral contacts will not be treated in the same manner as 
interviews with family /household members, other relatives, or neighbors. 
The worker must consider a variety of factors and techniques to complete 
interviews with adults in an effective, comprehensive and timely manner, 
including: 

language usage 

full expression of ideas /feelings 

reenactment of the incident 

discrepant information 

candor 

behavioral manifestations of feelings 

silence 

a. Language Usage 

The worker needs to communicate information in a concrete and 
specific manner, using commonly understood vocabulary, jargon or 
abbreviations, e.g.* 51A, should be avoided. Focusing questions 
and discussion on the child's health and safely will provide 
structure to the interviews and will minimize the number of dis- 
tractions which might interfere with the fact-finding process. 

Words that express blame should be avoided. For example, it is 
better to say "The agency has some concern about Cindy's physical 
well-being" rather than "The agency is trying to determing whether 
Cindy has been neglected . " The worker should avoid using value- 
laden language such as "what a horrible thing to do. " 

Serial questioning is used by workers to obtain information about 
specific factors and issues that are relevant to the fact-finding 
process. It differs from an open-ended approach to questioning 
in that it is tailored to elicit specific information. Because 
questions are less vague and less open to interpretation by the 
interviewee, answers provided will be more concrete and behavior- 
specific. For example, rather than asking the caretaker how he 
disciplines the child (which leaves the worker open to questions 
such as "what is discipline"?), a series of questions are asked 
to indirectly elicit information on the particular topic: 



-12- 



Does John listen to you when you give him instructions? 

Is John a cooperative child - does he follow instructions? 

How has John been acting lately? 

Is John difficult to manage? 

How do you control John's behavior when he does not want to do 
what you want? 

In addition to stating questions precisely, the worker should insure 
that the tempo of the interview is not hurried. 

b. Full Expression of Ideas /Feelings 

The worker should encourage interviewees to express their side of 
the situation in an open-ended fashion. Allowing him to convey the 
facts and his impressions will help to establish the worker's 
impartiality and will demonstrate respect for the interviewee's 
viewpoint. Workers need to be careful, however, that the use of 
"why" and "how" questions are not interpreted as accusations. 

c. Reenactment of The Incident 

The worker should consider using another technique to gather infor- 
mation about the incident in which the child was harmed. Speci- 
fically, the caretaker should be asked to demonstrate how the child 
received a particular injury by showing the worker where and how 
the incident occurred. This reenactment allows the worker to make 
specific observations about the scene of injury and simultaneously 
to discuss the specifics of the caretaker's account of the injury. 
This technique is particularly helpful when discussing injuries 
that the caretaker says are accidental. For example, observing the 
distance between a crib and the floor, the condition of the floor/ 
carpet, and the position and the movement of the child may pinpoint 
discrepancies which can be explored by additional questioning. 
When faced with the impracticality or implausibility of the explana- 
tion, the caretaker may be prompted to provide a factual account 
of the incident. 

d. Discrepancies in Information 

Discrepancies in the information provided during child protection 
investigations are inevitable. The worker should assume that this 
will occur and be prepared to acknowledge the inconsistencies. The 
interviewee must be confronted with discrepancies and be afforded an 
opportunity to clarify, restate and possibly negate information 
provided earlier. Confrontation is most effective when done in a 
calm, matter-of-fact, non-threatening manner. For example, "I'm 
slightly confused by the information that you have provided me. 
You first said that Pam turned on the hot water faucet when you left 
the room, but later you mentioned that you mistakenly turned on the 
hot water faucet while she was reaching for the soap." Clarifica- 
tions ohrased in this manner do not come across as accusations 
that the interviewee is lying. 



-13- 



e. Candor 

The worker must avoid the tendency to agree with everything the 
interviewee is saying or to offer false reassurance. Statements such 
as "everything will be fine," or "don't be so upset, there is 
nothing to worry about" create a false and often temporary sense of 
security for the interviewee. The nature of child protective 
investigations precludes guarantees in any form. A candid 
acknowledgement of the situation and range of possible outcomes is 
preferred to broken promises which weaken the worker's and agency's 
credibility. 

f. Behavioral Manifestations of Feelings 

The worker should be aware that a person who is uncomfortable or 
inexperienced with directly expressing feelings is more apt to 
express themselves indirectly through behavior. Feelings of anger, 
hostility, rejection or fear may be expressed by refusing to let the 
worker enter the home, keeping him waiting at the door, being pre- 
occupied with a television or radio program, and/or missing or 
being late for appointments. 

g. Silence 

When used appropriately by the worker, silence can be a very 
effective way to stimulate conversation. Many people are uncomfor- 
table with long pauses and are inclined to begin talking to break 
the silence. An added benefit is that the pause provides a break 
from the intensity of the emotionally laden topics being discussed. 
The worker should be careful not to break the interviewee's 
silence in his effort to reduce his own discomfort. 

9. Techniques For Interviewing Children 

The child who is the subject of the report must be viewed by the 
worker in order to make a determination regarding the allegations. 
In addition, these interviews provide the worker with valuable 
opportunities to gather information - particularly the child's 
perception and account of the situation and/or events which pre- 
cipitated his present condition. Because the child and caretaker 
may be the only "witnesses" to the abuse or neglect, the child's 
account is important in the process of determining whether 
sufficient evidence of abuse or neglect exists. 

When at all possible, the child(ren) should be interviewed alone 
and away from their parentis ), or other person responsible for 
their care, including the alleged perpetrator. 

Younger, nonverbal children must be seen although it may not be 
possible to interview them. 



-14- 



° In order to alleviate the fears or apprehensions of young children, 
they may be interviewed with an older sibling or another person that 
they trust who will not obstruct the interview. 

The techniques used by workers to interview children will vary. 
Selection of the appropriate techniques will be based on the worker's 
professional assessment of the child. Specifically, the worker must 
consider the child's: 

age 

maturity 

mental health 

primary language 

communication skills 

The following section highlights considerations and techniques which 
must be incorporated into the interviewing styles of workers for them 
to effectively interview children during the course of child protective 
investigations. These include: 

caretaker's cooperation 

individual interviews 

impact on the caretaker^child relationship 

play as an interview technique 

developmental considerations 

play equipment 

physical environment 

conducting the interview 

communication techniques 

self -blame 

clarity 

time considerations 

child's input into decisions 



-15- 



a. Caretaker's Cooperation 

The worker should explain to the caretaker the confidentiality of 
the information related by the child, and how the information will 
be used. Whenever possible, the worker should elicit the care- 
taker's cooperation in interviewing the child(ren). This will 
facilitate the interview as well as help to keep the child calm 
about the investigation and the questioning by a stranger. If the 
caretaker refuses to permit the worker to interview a child, the 
worker, in consultation with the supervisor, will need to assess 
what actions should be taken based on the allegations reported and 
the information he has been able to obtain. If the worker decides 
that an interview with the child is absolutely necessary, and the 
caretaker continues to refuse, the worker may need to consider 
taking protective custody or securing assistance. When the child 
is not in the caretaker's presence, e.g., at school, the worker may 
decide to interview the child without the caretaker's consent. 
Under these circumstances, it is best to inform the caretaker of 
this after the fact. In all situations, the child should be 
informed of how and when the caretaker will be or has been told 
about the interview. In general, a decision to interview a child 
without the caretaker's consent should be guided by an assessment of 
risk of future harm to the child. 

b. Individual Interviews 

For several reasons, interviewing the child and adult caretakers 
separately is preferred. 

If separate interviews are not conducted, it is unlikely that 
either the child or caretaker will feel free to speak openly. 

It prevents creating situations in which the alleged abusive or 
passive participants feel challenged by the child's statements 
and accusations* Such a confrontation not only impedes the fact- 
finding process, but may well place the child and others 
involved in danger. 

c. Impact on Caretaker-Child Relationship 

Interviewing the child may upset the balance of a precarious care- 
taker-child relationship. The interview may prompt the caretaker to 
become suspicious, fearful, jealous of or enraged with the child. 
Consequently, the worker must be prepared to assess the impact of 
the interview and the risk of future harm to the child. When the 
risk is significant , the worker will need to consider what steps 
should be taken to reduce the risk to the child and control for his 
safety. 

The interview may cause the child to experience a wide range of 
emotions, including fear, anxiety, and guilt at being asked to talk 
about private family matters. Under these circumstances, the worker 
must be prepared to discuss these feelings with the child in an 
effort to allay these fears and concerns. 



-16- 



d. Play as an Interview Technique 

One of the early decisions made by workers is how to interview the 
child. Recent attention has focused on the advantages of play as an 
interviewing technique in child protective services. 2 Recognized 
as the most natural medium for relating to a young child, play has a 
number of advantages. 

It provides workers with an effective method for establishing 
rapport while obtaining information about the child's experience. 

It provides a mechanism for the worker to capture the child's 
interest and to interact on a level that the child understands. 

It provides an opportunity to describe the situation while 
obviating the guilt, fear or anxiety of the situation for the 
child who has been coerced or coaxed into silence. 

It has an added advantage of promoting expressive responses 
rather than yes or no replies to closed ended questions. 

Its use in interviewing the young child can also be less threat- 
ening to the caretaker because it will be seen less frequently 
as a means of interrogation. As a result, the caretaker may 
be more willing to allow the child to be interviewed alone. 

e. Developmental Considerations 

Workers need to be aware of the child's developmental stage when 
they are considering the use of play or have an opportunity to 
choose from a selection of age appropriate play materials. 
Generally, the preschool child will readily occupy himself with 
puppets, dolls and fantasy play. He will also draw pictures and 
tell stories. The worker may wish to consider asking the child to 
draw a picture of his family and tell the worker about each person. 
The elementary school aged child will continue to play with dolls 
and puppets but will show more interest in art supplies and action 
toys. Early adolescents will be more interested in a direct inter- 
view, but may be engaged in table games. 3 

f. Play Equipment 

Although the use of dolls, puppets, and drawing supplies has been 
applauded for use with children, the unavailability of such equip- 
ment should not discourage the worker from the use of play inter- 
viewing. In addition to using whatever toys or props are available 
in the child's home, you can use the pens and paper that you bring 
to the interview. 

The young child's imagination makes it feasible to use a medium that 
is less symbolic, such a clothes pins, pencils, sticks, and paper 
clips. Workers who choose this technique should observe the child's 
visual expression as well as listen to the statements. The child's 
actions, nonverbal communication, and the products of play, e.g., 
drawings, are important components of communication. 



-17- 



The worker may use anatomically correct dolls when interviewing the 
child about allegations of sexual abuse. The anatomical features 
of these dolls provide the child with a visual representation of 
the parts of the body which can be used to demonstrate what took 
place. Because of the various terms used by children to identify 
genitalia, these dolls insure that the worker understands what the 
child is saying. Before introducing the dolls, however, the worker 
should spend some time building rapport with the child. 

g. Physical Environment 

The physical environment will affect how relaxed and comfortable the 
child is during the interview and should be adjusted to meet the 
needs of the child. The nature of the allegations should also be 
considered in determining where to interview the child. When 
possible, workers should interview the child in an area that will be 
free of interruptions and provide room for the child to move around 
and engage in play. Generally, it is not appropriate to interview a 
child alone in their bedroom. Workers should arrange to sit close 
to and facing the child and make every effort to sit on the child's 
level, e.g., on the floor or on a low chair. The impersonality of 
sitting across from the child, separated by a desk or table, should 
be avoided. 4 

h. Conducting the Interview 

The interview should be opened by the worker's introduction and with 
a simple explanation as to why he would like to talk with the child. 
The worker must be mindful of the child's maturity and communication 
skills throughout the interview. The five-year-old must be 
addressed differently from the more mature fifteen-year-old. As 
noted, the worker's assessment of the child's communication capa- 
bilities will determine which techniques are most appropriate. For 
example, the worker may ease into the interview by discussing the 
child's toys or pets when interviewing a five-year-old, or may adopt 
a similar tactic with the adolescent by focusing on hobbies or 
school interests. 

The content and the language of the conversation must be understood 
by the child. Jargon should be avoided. If the child appears 
confused, workers should restate or clarify the content of their 
communications. Similarly, if the worker does not understand a word 
or expression used by the child, ask the child to clarify it. If 
the child appears embarrassed, the worker can revert to the more 
general exchange until the child appears relaxed. Children should 
never be criticized for their choice of words, language or 
difficulty in articulating. 

At an appropriate time, the conversation will need to move from the 
general to the specific. At this time, the worker will need to 
determine what preparation the child has had for the interview and 
how the child feels about recounting the details of past experiences. 



-18- 



The worker should ask if the child understands why he came to talk 
to the child. If the child has not been prepared, the worker should 
address the issue honestly but delicately. 5 It is important that 
information provided to the child is accurate. Nonetheless, over- 
informing the child about the process and potential outcomes of the 
investigation can be overwhelming. The worker should use the 
child's questions as a guide for deciding how much information to 
share. 

i. Communication Techniques 

The effective use of the following communication techniques will 
enhance the interviewing process with the child: 

The worker needs to give the child undivided attention. 

The worker should control personal reactions to the child's 
statements so that they will not distract the child from 
sharing experiences. 

The worker should try to fit comments or questions into the con- 
text of the topic being discussed by the child in order to be 
responsive. Switching topics abruptly or interrupting the 
child's train of thought interferes with the discussion of the 
child's concerns. 

Avoid leading the conversation by suggesting responses. 

The tempo of the interview should be slow. 

j. Self -Blame 

In all circumstances, the worker must respond to expressions of the 
child's feelings. The worker should accept the child's feelings and 
provide support. Regardless of harm sustained, the child will still 
have strong positive feelings about the caretaker and may in fact 
feel responsible for the maltreatment. In order to counteract this 
self -blame, the worker should stress to the child that what has 
happened is not the child's fault or responsibility. If the child 
made the report, the worker should support and reinforce the child's 
initiative. The worker must refrain from speaking unfavorably when 
discussing the caretaker and other family /household members and 
should not expect the child to take sides against them. 

k. Clarity 

Workers should make every effort to clarify unclear and confusing 
information without suggesting answers or pressing the child for 
superfluous details or for information he is not ready to discuss. 
Nevertheless, the need for clarity must be balanced with the need 
to allow the child to describe experiences in his own way and at his 
own pace. At no time should workers try to frighten or intimidate 
the reluctant child into revealing information. Because intimida- 
tion is often used by the abuser, it can cause additional harm to 
the child and still fail to elicit the desired response. 



-19- 



1. Time Considerations 

Workers need to be aware of the child's conception of time. Young 
children, who cannot recount events according to the time of day 
or the day of the month/year, may be able to relate to the signifi- 
cant times in their life, e.g., seasons, school time, vacations, 
holidays, birthdays, meal times, bath time, television program 
slots. 

r 

m. Child's Input Into Decisions 

At some point, workers should consider asking for the child's opimnsm 
about how the situation could be resolved. To the degree possible* 
the child should have input into decisions that will affect him. 
However, the child should never be misled to believe that he mill 
influence decisions when this is not the case. In many instances* 
it will be beneficial to tell the child how decisions are mace. 

10. Techniques For Interviewing The Reporter 

The reporter is one of the most important sources of information about 
the allegations of abuse and neglect. In fact, the reporter may be the 
only other source, in addition to the child and caretaker, who has 
information about the harm to the child. Consequently, gathering com- 
plete information from the reporter is a critical part of a comprehen- 
sive investigation. As noted, remembering that each piece of informa- 
tion collected during the investigation is a key to obtaining additional 
facts should guide the worker's interviews with all persons, incl-udimp 
the reporter. 

Uoon receipt and review of the report, the worker should determine what 
additional information and detail should be secured from the reporter. 
The worker should confirm the information that has been entered on the 
reDort by contacting the reporter before contacting the child and care- 
taker, and gather additional information. 

The worker should utilize a variety of techniques during interviews mth 
the reporter. The worker will need to be sensitive to the feelings that 
the reporter may experience about having made the report, as well as to 
be prepared to deal with hesitancy about providing additional details. 
Exploring the reasons for the decision to make the report will provide 
an opportunity to gather facts about the condition and circumstances 
that have created harm or risk of harm to the child, as well as informa- 
tion about the reporter's motivation. This information is needed in 
order for the worker to assess the validity of the allegations and to 
support or unsupport the report. 



-20- 



The information about what has happened to the child is of particular 
importance. The worker should encourage the reporter to relate the 
history of events which preceded the notification of D5S, and to 
discuss how he became aware of the situation /circumstances. Although 
the relationship of the reporter to the child and family, e.g., the 
maternal grandmother who resides with the family, will often suggest how 
. the information Was obtained, the worker should pursue this line of 
questioning in an effort to elicit all relevant facts and details. 

If the reporter is unwilling to discuss the report and additional 
information is believed integral to completing a comprehensive investi- 
gation, then the worker should request supervisory assistance. 

11. Techniques For Interviewing Collateral Sources 

To complete a comprehensive investigation it is often necessary for the 
worker to interview persons outside the home who can provide factual 
information and additional perspectives about the child, caretaker, and 
family situation. 

The worker should seek to obtain the direct observations of collateral 
sources and should determine when and where the observations were made. 
Impressions can also be gathered if the collateral is able to distin- 
guish and label them as differing from the facts. 

The worker must make every effort to preserve the caretaker /child's con- 
fidentiality when interviewing collateral sources. The worker should be 
guided by revealing only that which is absolutely necessary to obtain 
the desired information. 

The worker should utilize the interviewing techniques discussed. In 
particular, serial questioning will be useful in exploring the collat- 
eral contact's knowledge of the child, her condition and the family 
situation. Examples of the use of this technique with a collateral 
source, e.g., a teacher > are: 

How long have you been teaching? 

What age level are you currently teaching? 

What subjects do you teach? 

During the past six months, have you noticed any children with 
extraordinary injuries that may not have been attributable to an 
accident? 

If yes, what children did you notice with these injuries or marks? 

What were the injuries? 

Did the child explain how the injury occurred? 

° When did you notice these injuries? 

Did the child's explanation make sense at the time? 



-21- 



Many collateral sources may be reluctant to share information with the 
agency regarding the child/caretaker. If so, the worker should consult 
with supervisory and legal staff. 

12. Techniques For Closing Interviews 

In closing the interview, the worker should summarize the major issues 
and feelings and ask the interviewee if there are any other concerns 
that he would like to discuss. The interviewee should have an opportu- 
nity to clarify any unclear or confusing information and should be left 
with an understanding of the purpose of the interview. Asking the 
interviewee to summarize what has gone on in the interview is one way 
to gage his understanding. Similarly, the worker should clarify any 
confusing or ambiguous information. 

The worker can begin to wind down the interview before terminating it. 
Do this by making it clear whether there will be future agency action, 
including whether you will be returning for additional interviews and, 
when possible, indicate the day and time of the anticipated return. The 
worker should inform the caretaker that the investigation will continue 
and that other sources of information will be contacted. The caretaker 
should also be told that he will be notified about the worker's pre- 
liminary conclusions. The worker should leave the office telephone 
number, but be certain to inform the interviewee that you are not always 
available. 

When a worker has concerns about future abuse and the child remains in 
the home, tell the child to contact you. This serves to link the child 
to the support and to underscore concern for the child, while providing 
a bridge to subsequent interviews. The child must understand that the 
worker is not always available. 

Before closing the interview, the worker should express appreciation 
for the interviewee's participation and continued cooperation. 

C. OBSERVATION TECHNIQUES 

Workers observe a variety of conditions and situations in conducting child 
protective investigations that will contribute to supporting or unsupporting 
an allegation of abuse and /or neglect. In order to be prepared to access 
harm or risk of harm to the child, workers must be equipped with information 
that will prepare them to make accurate observations and interpretations. 
Workers make observations about: 

medical /physical indicators of abuse and neglect 

behavioral indicators of abuse and neglect 

develoomental milestones of the child 



-22- 



° parental attitudes toward children 

intrafamilial interactions and functioning 

environmental factors - physical conditions in the home 

ecological factors - physical conditions of the surrounding neighborhood 

° influence of cultural biases 

Because observations can be clouded by subjective interpretations, workers 
must support their observations with specific data and tangible evidence. 
Tell the caretaker that you will be making observations regarding the 
child's safety and factors which contribute to or detract from it. 
However, you should make your observations as discreetly as possible. 

Everyone observes nonverbal communication during regular day-to-day inter- 
actions. While the worker may observe a variety of these communications, 
they must be interpreted accurately. For example, the worker may observe 
that the child avoids all physical contact with and remains at a noticeable 
distance from the caretaker at all times. While this behavior may suggest 
that the child is afraid of the caretaker, other interpretations are 
plausible. In fact, the family may have a rule that all physical displays 
of affection in public are inappropriate, prompting the child to behave 
as described. The variety of individual and cultural differences dictate 
that interpretations of observed behavior be tested and that supporting 
evidence be gathered before conclusions are made which are used to validate 
allegations of abuse or neglect. 

The worker should view the child's body for evidence of physical abuse. 
When a physical examination is necessary to verify the allegations, the 
worker can select from the following options. 

The worker should consult with the caretaker and offer three options: 

The caretaker and the worker can jointly disrobe the child and 
conduct a cursory physical examination. 

The worker and oarent can take the child to a physician or hospital 
emergency room for a physical examination. 

The caretaker can take the child to a physician or hospital 
emergency room for physical examination. 

If the child is at school, the worker should attempt to contact the 
caretaker before having the school nurse examine the child. The 
caretaker should be provided with the above three options, and a 
fourth one which involves having the school nurse examine the child. 
If the caretaker cannot be reached, the worker should have the 
school nurse examine the child. 



-23- 



There are a number of restrictions which apply to the preceding options. 
They are: 

Physical examinations of children alleged to be sexually abused should 
be conducted by a physician or other medical personnel, and not by the 
worker . 

Although it is preferable that a physician conduct an exam, if physical 
examinations are performed by the worker and the caretaker or other 
adult, for children over 13, it should be conducted by a worker who is 
the same sex as the child. Similar examinations of school-age children 
under 13 should be conducted by a person of the same sex as the child. 

A child who is severely ill should immediately be seen by a physician. 

(Please note that the manner in which the investigator views the child who 
is the subject of a report of abuse or neglect shall take into account and 
shall respect the child's age, sex, and other circumstances, particularly 
with respect to removal of the child's clothing). 

If the caretaker agrees to take the child to a physician, a time and day 
must be established before the social worker leaves the home. The investi- 
gator must follow up immediately after the scheduled visit to ensure that 
the caretaker complied with the agreement. If the caretaker did not, the 
investigator must locate the child and in consultation with a supervisor 
determine whether a medical examination should be obtained. 

The documentation recommended to verify and record the information secured 
through a physical examination is: 

Option 1: body chart 

(initialed by examiner with date and appropriate statement) 

Option 2: copy of medical chart 

interview with physician 

photographs, if taken (or notation that the physician or the 

hosoital has these available) 

Option 3: copy of medical chart 

statement of the physician 

Option 4: body chart 

(completed by school nurse and signed by worker as the witness) 

When a child has been seriously harmed and requires medical attention, the 
doctor or hospital physician who is treating the child is the appropriate 
examiner. The worker may, however, request that he be permitted to observe 
the physician's examination. 

1. Physical /Medical Indicators Of Abuse And Neglect 

Physical and medical indicators of abuse and neglect are a result of 
inflicted injury or lack of proper care and generally alter the child's 
physical appearance. Exceptions are those conditions which are only 
detectable through medical examination, e.g., certain bone fractures. 



-24- 



Refer to Appendix C for the glossary of medical terms relevant to child 
protective investigations. The range of physical and medical indicators 
of abuse and neglect which workers must be familiar with include the 
following: 



surface skin marks 



internal injuries 



mouth injuries 

burns 

head injuries 



sexual abuse 



poisoning 

° physical neglect 



These are discussed in detail in Appendix C. The diagram which follows, 
Figure 2A, illustrates the typical differences in location of accidental 
and abusive injuries. 



FIGURE 2A 
LOCATION OF INJURIES 



Location of Typical 

Accidental Injuria* 



Location of Typical 
Abuw-Ralatad Injur** 





kum li Ug.i'oiaOKwrewoi 



-25- 



2. Behavioral Indicators Of Abuse And Neglect 

Abused and neglected children may exhibit a variety of behavioral 
reactions to maltreatment. During the child protection investigation* 
the worker will observe the child's behavior and later will assess 
whether the behavior is harmful to the child or creates a risk of 
■ future harm. The assessment of harm should consider whether the 
behavior is exaggerated or typical of the child's interactions. Whe 
presence of any one of the indicators listed in Appendix E does mot mum- 
firm abuse and neglect; however, the presence of multiple indicators or 
pervasiveness of any one behavior that is dysfunctional or consistently 
aberrant must be assessed by the worker. As is evident, an individual 
behavior may be exhibited by all persons at any given time. For 
purposes of assessing harm or risk of harm, the intensity of the 
behavior is one clue as well as the duration and culmination of 
behaviors. 

Appendix E describes the following categories of behavioral inrfiuatorsz 

behavioral problems ° mood extremes 

psychoneurotic reactions ° interrelationship problem 

habit disorders ° overly adaptive behavior 

self-descructive behavior ° miscellaneous 

J. Developmental Milestones 

To comprehensively assess the child's safety and well-being, the mor^ksr 
needs to be familiar with the child's needs and developmental level. 
Appendix F provides examples of motor, mental, language and social mUe- 
stones at varying ages. Most milestones are fixed at the age at •which 
50 percent or more children accomplish a given task or obtain a givwm 
characteristic. 

This information is important for three reasons. First, equipped wdth 
knowledge of the motor, mental, language and social functioning of the 
"average" child of given ages, the worker is able to assess, through 
comparison, whether a child appears to be lagging development ally. 
Although not conclusive evidence of maltreatment, significant develop- 
mental lags may be a result of abuse or neglect. Detection by the 
worker of significant lags should prompt a developmental assessment oj 
trained personnel. Second, familiarity with developmental milestomes 
prepares the worker to determine if parental expectations of the child 
are realistic. High, unrealistic expectations of the child may pre- 
cipitate frustration and possibly lead to abuse by a caretaker. Third* 
knowing the physical /motor capabilities of children of different ages 
provides the foundation for assessing whether a child could have 
realistically sustained given injuries; that is, whether the explana- 
tions of injuries coincide with the child's motor development. 

A. Caretaker's Attitude Towards The Child 
And The Parenting Experience - 

During child protective investigations, the worker will encounter a 
range of parental attitudes toward children and the parenting experience. 
This information is included /considered in the assessment that the 
worker must make regarding the harm or risk of harm to the child. As 



-26- 



such, it is an important part of the decision-making process. Workers 
should note in particular if, in the interview, the caretaker:^ 

has rigid, unrealistic expectations of the child 

is unaware of normal developmental stages and milestones of 
children 

is unaware of constructive methods of discipline, alternatives to 
the one he uses 

describes the child in negative terms (e.g., as "bad" or "evil"), or 
is overly critical of the child 

considers the child unloving and ungrateful 

expects the child to provide an inappropriate amount of love and 
support 

blames the child for the agency's investigation 

is unable to provide a knowledgeable history of the child's develop- 
mental milestones, nutritional patterns, and daily activities 

does not exhibit emotional attachment to the child 

° cannot comfort the child and stiffens when the child approaches or 
begins to cry 

ignores the child, appears unconcerned about the child's well-being, 
or talks about the child in the third person while the child is 
present 

effects a parent-child role reversal, resulting in the child 

becoming the source of unrealistic expectations and the recipient of 
delegated authority 

verbalizes frequent frustration and disappointment with the child 

appears jealous or overprotective of the child 

"scapegoats" the child or appears to favor one child over another 

Of additional concern are factors that may shape or have shaped the 
caretaker's attitudes and expectations about the parenting experience, 
e.g., the caretaker: 

was abused or neglected as a child 

describes her own parents as having used excessive discipline or 
punishment 

feels antagonistic toward his own parents 

describes her parents as uncaring, uncomforting, unloving, or 
unable to meet her needs 



-27- 



describes his homelife as being chaotic 

has no contact with his own parents and /or siblings 

had excessive demands placed on him as a child 

. ° has a history of psychological problems or mental retardation 

appears unaware of and/or cannot provide for his own adult emotional 
needs 

appears to have low self-image /esteem and expects rejection 

is unable to control impulses 

has inadequate coping skills 

is isolated or has an inadequate support system 

lacks skills to effect positive change in his life 

5. Family Functioning 

The varied theories and research which focus on abuse and neglect under- 
score the contributory role of the emotional environment and inter- 
personal dynamics within the home. Consequently, the worker needs to 
consider family functioning when assessing harm to the child. The care- 
taker's' attitudes toward the child, and the parenting experience which 
shape interactions, will provide the worker with clues to assess the 
intrafamilial functioning and may underscore the family problems that 
have contributed to the harm or risk of harm to the child. During 
interviews with family members, the worker will gather information about 
the problems the family is experiencing and the relationships between 
family members. Interactions during joint interviews will provide 
clues, as will possible discrepancies in the accounts provided by 
various family members as to the family's level of functioning and 
explanation of the child's injury. During successive interviewing, the 
"family story" about what has precipitated harm to the child may break 
down, as well as their assertions that the family is not experiencing 
difficulty in carrying out their caretaking responsibilities. 

The following information gleaned from interviews with family members 
is important to the assessment of family functioning and its contribu- 
tion of harm to the child. These include the story of the incident, the 
possible crisis leading to this event, and the contribution of stress to 
the crisis. Although obtaining a detailed social history /social 
assessment of the family may be the responsibility of a follow-up 
worker, the investigating social worker will be privy to information 
that will be an important part of assessment. For example, finding out 
that the mother is an abused wife provides the worker with a clue that 
family interactions may be characterized by physical violence and/or 
that violence is an acceptable means of interaction. 



-28- 



Additional observations which may be important in the assessment 
process by the worker include the following: 7 

One caretaker is completely silent during the interview. 

The caretakers display an inability to listen or talk to one another. 

The caretakers are openly antagonistic towards each other and argue 
in the worker's presence. 

The caretakers are unable to rely on each other under stress. 

The conflicts between the caretakers seem to be blamed on or taken 
out on the children. 

There appear to be no family routines or rules. 

Family members appear to be working against each other rather than 
working together. 

The caretaker strikes the child or is hostile to the child or other 
caretaker in the worker's presence. 

The caretaker or child appears uncomfortable in the other's 
presence. 

The, child attempts to comfort the caretaker, indicating a reversal 
of roles. 

The caretakers are over-solicitous of the child, or overly 
solicitous of one another. 

The caretakers appear to be protecting or covering for one another, 
and their explanations are contradictory. 

Incidents of abuse and neglect may be precipated by stress. Caretakers 
whose own childhood experiences make them vulnerable to the stresses of 
the social environment in which they live may be more likely to respond 
to this stress with abusive or neglectful behavior. Often, the stress 
is minor by the average person's standards, yet major to the caretaker. 
Consequently, information regarding crises or presistent stress that 
the family is experiencing is important in assessing the harm or risk 
of harm to the child. The variety of situations and conditions which 
precipitate stress include the following: 

families living in poverty and impoverished environments 

job loss and unemployment 

alcohol or drug addiction 

gambling 

serious marital discord 



-29- 



single parenting 

social isolation 

birth of a new baby 

relocation of family to different geographic area 

death of significant other family member 

onset of a serious medical problem in the family 

family member has a developmental disability and is being cared 
for in the home 

6. Environmental - Physical Conditions In The Home 

The physical conditions in the home may harm or create a risk of harm to 
the child. The presence of these conditions alone may not warrant con- 
cern, particularly in light of the age of the child. However, the 
presence of conditions which create risk of harm coupled with an absence 
of oarental awareness or concern for how they may harm the child should 
be part of the worker's assessment. In order to assess harm or risk of 
future harm, the worker should be aware of conditions in the home which 
create a risk for the child's safety and well-being. To make an 
assessment, the worker should be aware of the following: 

bare electrical wires, dangerous electrical outlets, or frayed 
electric cords 

exposed heating elements or fan blades 

no railings on stairs, broken stairs, or open windows 

broken, jagged, or sharp objects lying around the home 

chemical substances or dangerous objects, e.g., knives, guns, 
improperly stored and within reach of children 

human or animal feces or garbage which have been inappropriately 
disposed 

indoor /outdoor bathroom facilities that are inoperative 

adequate, e.g., quantity, sanitation; sleeping provisions, e.g., 
beds, cots, mattresses and/or blankets, for all; including a place 
for the infant to sleep which has sides that prevent falling out 

infestation by rodents or vermin 

vicious or uncontrolled animals in the home 

operable electricity and heating, e.g., above 50° in cold weather, 
in the home 



-30- 



° small objects that can be swallowed within reach of the child 

objects lying about the home that the child might fall over or be 
injured by 

sufficient quantity of nutritious food to meet the child's needs 
which is edible and not rotten, moldy, insect-infected, or in any 
other way contaminated 

equipment and provisions for cooking and refrigerating food 

Although many of these conditions will be apparent through the worker's 
observations, the worker will need to discuss them with the caretaker. 
In particular, the worker will need to know what precautions the care- 
taker has taken to protect the child from potentially harmful conditions. 

7. Ecological - Physical Condition Of The Surrounding Neighborhood 

In addition to the physical conditions within the home, those of the 
surrounding neighborhood may harm or create risk of harm to the child. 
The presence of these conditions alone may not warrant concern if the 
child is capable of minimizing the potential harm they create or if the 
caretaker appears to be taking steps to limit or minimize the possibility 
that they will harm the child. Again, the presence of these condi- 
tions, coupled with the caretaker's lack of awareness of how they are 
harming the child, or a lack of the caretaker's effort to prevent their 
continued harm should be a part of the assessment made by the worker. 
Potentially harmful conditions which should be discussed with the care- 
taker and assessed by the worker to determine their condition to the 
harm include: 

drug trafficking 

high incidence of violent crime 

abandoned /condemned buildings to which the child can gain entry 

railroad tracks and/or highways to which the child has ready 
access 

unprotected waterways, e.g., rivers, wells 

construction or other industrial sites to which the child has 
ready access 

8. Cultural Biases And Influences 

The task of investigating abuse and neglect must take into account the 
culturally acceptable standards for child rearing within a given 
community. Be careful not to view the child-rearing practices of a 
different culture as deviant merely because they differ from your own 
or the norm of the majority group. At the same time, workers must not 
accept deviant practices that are harmful to the child by automatically 
justifying them as reflective of cultural, class, or religious 
di fferences . 



-31- 



Gathering complete information is important when assessing harm or risk 
of harm to the child, as is the necessity of understanding the cultural 
context within which behavior occurs. What is considered an unaccept- 
able practice by the majority culture may not be viewed as harmful with- 
in its cultural context. For example, a worker reared in a nuclear 
family may view a situation in which multiple extended family members 
care for a child as emotionally neglectful because the child is mt 
being reared by a single caretaker or pair of caretakers. When investi- 
gating a report with this type of allegation, the worker, who (because 
of his own cultural biases) fails to understand that caretaking 
responsibilities are shared among extended family members, will mt be 
prepared to gather sufficient information to assess harm to the child, 
e.g., he might not interview relatives assigned caretaking responsi- 
bility. In order to make a determination, the worker would need to 
interview the extended family members who have significant caretaking 
responsibilities . 

While not exhaustive, the following questions should be considered by 
the worker in an effort to identify information that should not be over- 
looked during the investigation. & Information gleaned from the family's 
responses will provide the basis for assessing harm or risk of harm to 
the child with recognition to the different child-rearing practices of 
various culture groups. 

Which persons are commonly expected to share in child-rearing 
responsibilities? What is the role of older persons or extended 
family members in assuming caretaking responsibilities? 

Who is the source of ultimate authority in the family? The worker 
should identify that person and relate as much as possible to that 
person. For example, although in the traditional Hispanic family 
the mother is the primary child raiser, the father is considered 
the decision-maker and head of the household. Therefore, the father 
may have to be involved in any decisions concerning the welfare of 
the child. 

How geographically mobile is the family? For example, the worker 
should consider that the lifestyle of a migrant farm family will 
differ significantly from that of an urban or suburban family, 

What are the differing views of men /boys and women /girls in the 
culture? How does this affect the disciplining of the child? 

What are the cultural groups attitudes toward childbirth among 
unmarried adults? 

To what extent has the family been acculturated? Some families have 
a stronger ethnic identity than others. Therefore, it may be 
inappropriate to assume that some cultural practices are observed 
in the home. For example, some Native Americans born outside of 
the reservation may have values that more closely resemble the 
dominant society than the tribe to which their family belongs. 



-32- 



If the worker observes a practice in the home that he is not familiar 
with, he should not hesitate to ask the family to explain and discuss 
the cultural significance of the practice. 

The worker's inability to speak the family's language will affect all 
interactions. The absence of a common language may lead to miscommuni- 
■ cation and to misunderstanding . Where lack of a common language exists, 
the worker should use an interpreter but should be aware that the 
feelings, perceptions, and possible misperceptions of the interpreter 
may be introduced into the translations. The worker who must rely on 
this indirect communication process should consider learning at least 
a small repertoire of phrases in the individual's language. Familiar 
words and terms should be used while avoiding a patronizing tone, slang 
or unfamiliar dialect. In addition to facilitating communication, this 
will convey the worker's awareness of the cultural differences and 
assist the development of rapport. 

A variety of sources should be explored when an interpreter is needed. 
Using the assistance of other DSS staff is preferred in that it pre- 
serves the confidentiality of the subjects of the report. When such 
assistance is not available the interpreter may be from the following: 

contracted agencies 

local cultural societies 

religious organizations 

universities 

At all times, the confidentiality of the information discussed must be 
stressed . Accordingly, the worker should rely on persons and groups 
known to the Department when the service of an interpreter is needed. 
Supervisory personnel will play a key role in identifying such sources. 

D. TECHNIQUES TO OBTAIN DOCUMENTS /PHYSICAL EVIDENCE 

Gathering secondary information includes collecting information from 
collateral sources such as physicians, mental health providers, police 
officials and the records maintained by them. In addition to supplementing 
the information obtained through interviewing and observation of the child 
and family, securing secondary information provides a mechanism for 
balancing the subjective aspects of the worker's fact-finding, e.g., the 
statements and impressions of collateral contacts. This information may 
be important in supporting allegations of abuse and neglect and may be 
critical if a case is referred to the courts. It provides another dimension 
to the worker's observations, conclusions and recommendations and, when 
necessary, facilitates resolution of varying interpretations of the evidence. 

Because of the importance of thorough documentation and comprehensive record 
keeping, particularly for court presentation, the worker should regularly 
collect secondary information. Although court involvement may not be anti- 
cipated during the initial investigation, the possibility of this action at 
a later time necessitates that records be maintained in a comprehensive 
manner. 

-33- 



1. Medical Examinations 

If the investigative worker believes that the injury to the child 
requires immediate medical treatment, arrange for a medical examination 
and treatment. The worker should consider the following conditions of the 
child when determining whether immediate medical attention is necessary: 

difficulty in breathing 

unexplained seizure 

appears seriously ill/injured and is unresponsive 

appears to be in a coma 

high fever 

unusual or severe bleeding 

prolonged diarrhea or vomiting 

loss of movement in an extremity 

symptoms of failure to thrive 

unusual burns or bruises 

untreated conditions or infections 

When immediate and intensive medical diagnosis and treatment are indi- 
cated, medical intervention should receive priority over other parts 
of the investigative process. Securing a medical examination, including 
x-rays and photographs, should also be considered in non-emergency 
situations when this information /evidence is believed necessary to sup- 
port the allegations of. abuse and/or neglect. 

2. Mental Health Evaluations 

In general, the worker should secure a mental health evaluation when the 
child exhibits bizarre or exaggerated behavior or speech /statements, or 
if there is a need to secure information about the child's developmental 
needs and deficiencies. The behavioral indicators of abuse and neglect 
included in Appendix D delineate behaviors which may indicate that the 
child is experiencing emotional /psychological or developmental problems. 
As noted, the worker must be attuned to whether the child's behavior or 
statements are pervasive, exaggerated or bizarre . 

A child who is threatening to physically harm or kill himself must be 
taken seriously. Obtaining a mental health evaluation for this child 
is strongly recommended. Other situations which suggest the need for 
the investigative worker to secure a mental health evaluation include 
the following: 



-34- 



The child is hysterical and cannot be calmed within a reasonable 
amount of time. 

The child has self-inflicted injuries by non-accidental means. 

The child's behavior or statements are bizarre, suggesting that the 
child may be out of touch with reality. 

The child is physically abusive to other individuals and is unable 
to control this aggression and results in his endangering the safety 
of another person, e.g., the caretaker, siblings, the worker, etc. 

The worker must assure that psychiatric and psychological evaluations 
are oroperly used. The critical issue is, does the child's condition 
indicate that the child has been harmed or suggest that the child is at 
risk of future harm? All other analyses and information gleaned from 
such evaluations are extraneous to the question before the agency and 
should be regarded as such. 

Obtaining mental health evaluations during the investigation serves two 
important purposes. First, it is a means of obtaining emergency mental 
health services when the child's condition necessitates such services. 
Second, these evaluations provide relevant and important information 
regarding the harm and risk of harm to the child that is needed for the 
worker to carry his mandated responsibility to support or unsupport 
a report. 

3. Written Documentation 

Information provided by collateral sources should be documented. Copies 
of this documentation may be secured by the worker for inclusion in the 
case record. Evidence may play an important role in court proceedings. 
When official reports /records are not available from the collateral 
source, the worker should consider securing a written (and signed) 
statement which stipulates the major points made by this individual. If 
the record/report is available but the collateral refuses to release it, 
the worker should seek supervisory assistance. At a minimum, the worker 
should document that the information exists. 

A. X-Rays 

X-rays should be taken of children to identify those injuries that are 
not visible. X-rays may be authorized only by a physician as part of 
the physical examination of an allegedly abused child. A physician may 
consult with the DSS worker regarding the advisability of x-rays. For 
example, he may request DSS permission to order the x-rays when he needs 
them to complete an examination and DSS has taken protective custody of 
this child. If a worker suspects or knows of previous abuse which the 
doctor may not be aware of, the worker should so notify the doctor and 
suggest that x-rays may be beneficial in the doctor's analysis. 

5. Record Availability 

When a social worker is denied access to records pertinent to a specific 
reoort, he must consult with his supervisor and DSS legal counsel. 



-35- 



E. ACTIONS TAKEN DURING THE INVESTIGATION 

During the investigation, the worker may take a number of actions to protect 
the child from future harm, including securing emergency services. In all 
investigations, the worker must inform the caretaker and child of the out- 
come of the investigation, notify the ASSIST System of the findings of the 
investigation, provide feedback to reporters, and effect a disposition, 
e.g., support or unsupport the report. 

1. Emergency Intervention 

When it is determined that a child's safety is threatened, a plan to 
prevent additional harm must be developed and implemented. A variety 
of intervention strategies are possible, including: 

maintaining the child with the family 

securing emergency medical / psychiatric treatment or hospitalization, 
and maintaining the child with the family 

taking temporary protective custody and placing the child 

a. Maintaining the Child With the Family 

Parents or caretakers who are willing and able to cooperate in the 
protection of the child may be given the opportunity to suggest 
alternatives to protective custody which assure the safety of the 
child(ren ). Examples include: placement with a relative, relocation 
of the alleged perpetrator and/or acceptance of emergency caretakers. 

When separation of the child and alleged perpetrator is deemed 
essential to insure the immediate safety of the child, the worker 
may consider seeking removal of the alleged perpetrator from the 
home. This option may be less guilt-provoking for the child and may 
not be viewed as punishment by the child. It also reduces the like- 
lihood that other children in the home will be abused. Consider- 
ation of this option, however, must address the possibility of other 
members of the family blaming the child for the removal of the 
alleged perpetrator. 

In some circumstances, the worker may convince the alleged perpetrator 
that it is in the child's best interest for him to leave. A worker 
may want to consider eliciting the help of significant others, such 
as relatives and close friends who are closely involved with the 
family to achieve the separation. 

b. Temporary Protective Custody 

Chapter 119, Section 51 (B) and (C) specify conditions under which 
the Department and/or physicians may take protective custody of 
children at risk of abuse and neglect. 



-36- 



2. Providing Feedback To The Caretaker And Child 

Informing the caretaker and child of the findings and outcome of the 
investigation is an imoortant activity performed by workers in the 
final stage of the investigative process. When intervention is to be 
provided, this feedback will serve to bridge the investigatory and 
follow-up components of the Department's service. In addition to the 
letter notifying the subjects of the findings, the worker should contact 
the subjects either in person or by phone to tell them what recommenda- 
tions he will be making. 

J. Providing Feedback To The Reporter 

Mandated reporters who reported suspected child abuse and neglect must 
be provided written notice of the determination of the investigation. 

4. Notifying The Central Registry Of Investigative Findings 

The worker must notify the ASSIST System of the investigatory findings 
and indicate whether the allegations were supported or unsupported. 

5. Effecting An Investigative Disposition 

Upon completion of an investigation of abuse or neglect, the social worker 
must make a decision as to whether there is reasonable cause to believe 
that abuse or neglect exists. This decision shall be based upon whether 
the information gathered from other persons during the investigation and 
the direct observations made by the social worker during the investigation 
constitute reasonable cause to believe that a child has been abused or 
neglected. 

DSS procedures specify that allegations may be determined to be supported 
or unsupported: 

To support a report- means that the Department has reasonable 
cause to believe that an incident (reported or discovered during 
the investigation ) of abuse or neglect by a caretaker did occur. 

To unsupport a report means that the Department has no reasonable 
cause to believe that an incident of abuse or neglect by a caretaker 
did occur. 

When a social worker determines that a report is supported, parents 
have the opportunity to cooperate with the Department through services 
provided for or arranged by the Department. If the parents or care- 
takers are unwilling or unable to cooperate, or when they do not agree 
with the worker, court intervention may be sought. In certain circum- 
stances, the presence of imminent danger to the child will necessitate 
immediate provision of emergency services. 



-37- 



In other circumstances, the worker will determine that a report is 
unsupported but that the family situation suggests the need for 
services. In these cases, the social worker will offer voluntary 
services. 

When emergency services are required, the investigative worker must 
provide such services and complete the child orotective investigation. 

When during the course of the investigation it becomes evident that the 
report does not constitute a case of abuse or neglect, the worker should 
conduct the minimum number of investigative interviews. 



-J5- 



FOOTNOTES 



1. Diane D. Broadhurst and James S. Knoeller, The Role of Law Enforcement in 
the Prevention and Treatment of Child Abuse~and Neglect (Washington, D.C.; 
National Center on Child Abuse and Neglect, U.S. Department of Health, 
Education and Welfare, 1979: p. 39 (DHEW Publication No. (OHDS) 79-30193). 

2. Virginia Eaddy and Charles Gentry, "Use of Play in Interviewing Abused/ 
Neglected Children," Public Welfare 39 (1, Winter 1981); pp. 43-47. 

Ann W. Burgess and Lynda Holstrom, "Interviewing Young Victims, " in 
Ann W. Burgess et al., eds. Sexual Assault of Children and Adolescents 
(Lexington: Lexington Books, 1978). 

3. Ann W. Burgess, et al, "Counseling Young Victims and Their Families," in 
Ann W. Burgess et al., eds. Sexual Assault of Children and Adolescents (see 
above). 

4. V.B. Eaddy and C.E. Gentry, op. cit. and A.W. Burgess and L.L. Holstrom, 
op. cit. 

5. Ibid, pp. 43-47. 

6. Creative Associates, Inc., Child Protective Services: Inservice Training 
for Supervisors and Workers (Washington, D.C.: National Center on Child 
Abuse and Neglect, U.S. Department of Health and Human Services, 1981); 
op. III-ll (1-3) 

7. Ibid., p. 111-12. 

8. This information is adapted from: James Green, "Roles and Responsibilities 
of Service Providers in Culturally Diverse Communities," Deoartment of 
AnthroDology, University of .Washington: Summary of Presentation at the 
Fourth National Conference on Child Abuse and Neglect, Los Angeles, 
October 1979. 

and 

Creative Associates, Inc., p. IV-13. 



-39- 



CHAPTER II 
DECISION MAKING 



II. DECISION MAKING 



A. INTRODUCTION 

A primary focus of the Reference Guide for Child Abuse and Neglect Investi- 
gations is decison making. A child abuse/neglect investigation is a fact- 
finding process in which evidence is collected, analyzed, and weighed in 
order to make decisions which assure adequate protection of children. 
Accordingly, the social worker is required to make a variety of decisions 
which affect the child's health and safety, and which affect the manner in 
which the investigation is conducted. Examples of the decisions are: 

The child's health and safety are (are not) in jeopardy from past or 
future abuse /neglect. 

The child should (should not) be removed from his home in order to 
assure his safety. 

There is (is not ) reasonable cause to believe that abuse or neglect 
exists. 

To make correct, timely, and carefully considered decisions, the social 
worker must draw upon the resources provided in the other chapters in order 
to: 

i 

understand investigative roles and responsibilities and how to secure 
the assistance of other individuals in obtaining information, 

6e aware of and skillful in the use of a variety of investigative 
techniques, 

comprehend the basic rules of evidence and their application to the 
investigation, 

properly record investigative data, and 

apply the appropriate skills, techniques, and knowledge to weighing 
evidence and making decisions. 

Making decisions in extreme investigative circumstances is simple. When a 
social worker finds a two-year-old child lying in a corner of his bedroom 
closet with a broken arm and symptoms suggesting internal injuries, the 
decisions to take protective custody and secure emergency medical treatment 
are easy ones. 

Decisions become difficult when medical evidence is inconclusive, when 
stories conflict, when there is no eyewitness to the alleged incident, and 
when collateral information sources do not corroborate the reporter's 
suspicions. 

In order to help social workers make correct decisions in difficult circum- 
stances, this chapter delineates a systematic, structured approach to making 
decisions which include the following elements: 



-40- 



identification of standard investigative decisions, 

factors and variables which assist in measuring the risk of harm to a 
child in light of the child's condition and family /home circumstances, 

guidelines on weighing and comparing the reliability and importance of 
evidence, and 

enumeration of factors used to analyze facts and evidence. 

B. CHAPTER OVERVIEW 

The chapter organization is a reflection of, first, the need to describe the 
decision-making process in general and, second, the need to apply this 
process to specific decisions which have been classified into two types: 

assessment of risk of harm 

major investigative decisions 

Accordingly, the first major section focuses on general decision-making 
orinciples supplemented by investigative examples. It reviews and rein- 
forces the mental steps the worker must go through in order to make a 
correct, timely decision. The discussion formulates the conceptual frame- 
work for the analysis of subsequent investigative decisions. 

Of prime importance to the investigation is the ongoing evaluation labeled 
"assessment of risk." Protection of the child is of paramount concern to 
the social worker who must be able to determine the relative level of risk 
to the child. As each new piece of information is gathered about the 
child's physical condition, the home, or the adequacy of the caretaker's 
actions in protecting the child, a reassessment of risk is made. This 
process, which begins with report receipt, ends only after the social 
worker has supported or unsupported the reported allegations. 

The assessment of risk influences the remaining investigative decisions. 
The decision to take temporary protective custody, secure emergency ser- 
vices, or request police intervention may be influenced to a significant 
degree by the risk assessment. A subsequent alteration of the original 
assessment will change the investigation. For example, a child may be left 
at home if initially judged to be at low risk of harm. After interviewing 
the emergency room physician about laboratory tests and x-rays, however, 
the social worker may reassess the risk. 

Accordingly, the final section presents the major investigative decisions 
which represent a compilation of concerns regarding: 

protection of the child 

securing complete and accurate information 

the completeness of the investigation 

involving external agencies and individuals 



-41- 



C. DECISION-MAKING PROCESS 

Making decisions which affect a child's future to the extent that his life 
or health may depend upon the outcome may be stressful and difficult under 
the best of circumstances. Given the crisis nature and limited timeframe of 
a child abuse/neglect investigation, the social worker must make a variety 
of important decisions based on imperfect or incomplete information. Accord- 
ingly, it behooves the social worker to adopt a methodological approach to 
making decisions to assure that: 

enough pertinent information is gathered 

evidence is cross-checked to determine its accuracy 

the reliability and importance of evidence is weighed 

all possible factors and outcomes are considered 

The systematic decision-making model described in this chapter includes the 
following key components: 

identifying and defining investigative decision questions 

determining what information is necessary to answer the decision 
question 

° gathering evidence 

cross-checking and validating evidence 

comparing the evidence on specific factors 

consultation 

As social workers gain experience in making decisions, the first three com- 
ponents become a routine aspect of every investigation. Armed with the 
knowledge of which decisions will be required, the social worker may struc- 
ture his activities accordingly. The amount of cross-checking required will 
vary with the report, the amount of conflicting information, and the reliabi- 
lity of the interviewees' information. The fifth component is perhaps the 
most important, as it structures how the evidence is weighed and assures 
that all pertinent factors impinging upon the decision are considered. Con- 
sultation with a variety of individuals may help the investigator make 
difficult decisions. 

A decision-making model serves only as an infrastructure; the skills, 
experience, and professional judgements of the social worker must be con- 
tinually applied to this foundation in order to make the model /process 
responsive to the unique circumstances of the investigation. 

I. Identifying And Defining Investigative Decision Questions 

A wide variety of decisions will be made during an investigation, 
primarily by the social worker. As these decisions vary in importance, 
a number of major decision areas have been identified and are defined 
and discussed in the following section: 



-42- 



Each question should focus on one topic. 

Rather than the question "What interview and observation techniques 
are appropriate for this child?", the social worker should first 
determine "What interview techniques are appropriate for this child?", 
and then broach the observation technique questions. The outcome 
of the former question will have an impact on observation techniques 
used. For example, if a child is interviewed with siblings rather 
than alone, the observation technique must include analysis of group 
dynamics, sibling rivalry, peer pressure, family customs, etc. 

Each question must be as specific as possible, based on the data 
available. 

Formulating decision questions in specific terms helps the social 
worker focus on the report allegations and investigative concerns. 
For example, the question "What investigative techniques are appro- 
priate for an eight-year-old female who was allegedly sexually abused?" 
provides more structure for the decision-making and investigative 
process than "What interview techniques shall I use?" 

Each question must pertain to the investigation and to report alle- 
gations. 

If the report allegations are "inadequate shelter" and inadequate 
food" and there is no indication of "educational neglect", the 
social worker may not be concerned with obtaining school attendance 
records. Extraneous decisions slow the investigation and render 
timely action unlikely. 

Each question must be answerable. 

The social worker must be qualified to answer the question posed or 
able to obtain information to do so. If the decision question is 
"Are the parent's motor capabilities adequate to protect the child?", 
either the social worker must be a trained diagnostician, or a 
trained professional must be available to undertake the tests 
necessary to provide information to make this decision. Otherwise, 
the decision cannot be made. 

2. Determining What Information Is Necessary To Answer The Decision 
Questions" 

Decision-making is a process dependent on information (evidence ). With- 
out information, a social worker cannot reliably make correct decisions. 
Having identified the types of decisions which will be made, the social 
worker may develop a systematic approach to determining the information 
required. A systematic approach will prevent the social worker from 
sifting aimlessly through irrelevant data. Identifying required infor- 
mation prior to field work will help in the formulation of an efficient 
and timely investigative plan. 

To illustrate the identification of information pertinent to a specific 
question, the following was formulated: "What interview technique is 
appropriate for a child allegedly sexually abused?" Information similar 
to that listed below would be identified as necessary to make the 
decision: 

-43- 



child's age 

child's gender 

child's current location 

child's relationship to alleged perpetrator (sibling, parent's 
paramour, mother) 

child's potential responsiveness to play techniques 

availability of anatomically correct dolls 

The amount and type of evidence required will vary with the investiga- 
tion, the type of allegations, whether court involvement (protective 
custody) is necessary, prior history of abuse /neglect, and related 
factors. 

3. Gathering Evidence 

Collecting evidence requires the application of a variety of investiga- 
tive techniques. The techniques include, but are not limited to: 

personal observatons of the home, child, neighborhood, family 
interactions, etc. 

interviews with report subjects and collateral sources of 
information 

collection of physical evidence - photographs, x-rays, and labora- 
tory texts 

The techniques selected must be appropriate to the investigation. For 
example, a physical examination by a medical professional is recommended 
for sexual abuse investigations. For a cut /bruise /welts allegation, 
however, it may be more appropriate for the caretaker and the social 
worker to examine the child's body jointly for evidence of injuries than 
to take the child to a physician. The number of sources contacted will 
depend upon the report and the level of knowledge regarding the incident/ 
allegations possessed by external sources. Furthermore, the social 
worker may choose to contact professional sources of information, 
oarticularly medical or mental health personnel, who may be willing to 
share confidential client /patient information with the social worker. 

4. Cross-Checking And Validating Evidence 

Frequently, evidence gathered from different sources during the investi- 
gation conflicts or is inconclusive. Accordingly, the social worker 
should cross-check (verify or double check) all statements provided by 
report subjects and collateral sources. This verification process 
assures the accuracy of the information collected, and is necessary 
because: 

Individuals may lie to hide their responsibility for the abuse or 
neglect. 



-44- 



The information source may be biased for or against the alleged 
perpetrator and report subjects. 

Memories of specific dates, times, and places fade with time. 

Interviewee interpretations and opinions may not be separated from 
facts. 

Report subjects may change their account of the incident during 
the investigation. 

The reliability or trustworthiness of the information source is an 
important clue to the, weight or credibility assigned to the resultant 
evidence. The following factors should be considered is assessing 
reliability: 

Professional expertise (medical, law enforcement, mental health, 
social work, etc. ) 

Education, training, and experience may qualify persons (including 
the social worker as experts in their field. For example, certain 
report allegations - subdural hematoma, failure to thrive, malnutri- 
tion, etc. may require a medical diagnosis in order to substantiate 
the report. The physician's diagnosis is inherently more reliable 
than an explanation provided by a person with no medical training. 

Non-involved third party 

The more removed a person is from the individuals involved in an 
incident, the more likely he is to be objective. A stranger passing 
by a house who sees a man drop an infant four feet to the ground is 
personally involved in the incident and is therefore likely to be 
more objective than an involved person such as the child's mother. 

Eyewitness - direct observation 

In limited situations, an eyewitness account by a noninvolved third 
party can be more reliable than a professional's analysis. The 
professional is generally involved in the situation after the injury/ 
neglect presented to him. The eyewitness, if observant, can explain 
exactly how the incident occurred and thereby eliminate any "guess- 
work" by the professional. 

It is important to remember, however, that although evidence may be 
reliable, sound, and accurate, it may not be relevant to the investiga- 
tion. For example, the fact that a child's home provides adequate 
shelter does not help the worker determine if sexual abuse has occurred. 

Evidence which is generally unreliable and therefore may be of question- 
able significance includes: 

hearsay 

information from an involved party 



-45- 



data from a biased source (neighbor engaged in a boundary-line 
dispute, ex-spouse, etc. ) 

information which cannot be verified by a second source 

5. Comparing The Evidence To Decision-Specific Factors 

Decision-making may be facilitated through evaluation of investigative 
data in light of preselected, standardized factors which impinge upon 
the decision. The prime example of this process is the assessment of 
risk, in which factors are identified which reflect the risk of harm to 
the child. A child is considered at higher risk for that factor if the 
alleged perpetrator lives in the home and has ready access to the child. 
On the other hand, a child is a lower risk for that factor if the alleged 
perpetrator lives elsewhere and has no access to the child. Similar 
analyses are undertaken for each of the factors, and a final deter- 
mination is made regarding the level of risk to the child. 

6. Consultation 

Social workers do not work or make decisions in a vacuum. A variety of 
professionals are available both within the Department and in allied 
agencies and organizations to assist in the decision-making process. 
Consultation is appropriate at any stage in the investigation. The 
social worker's primary consultant in making decisions will be his 
supervisor. Other likely sources include: 

the Department 's legal counsel 

hospitals and physicians 

other Department staff 

other helping professionals 

7. Summary 

The decision-making process may be viewed as a scale on which different 
types and amounts of evidence are weighed (see Figure 3A). The decision 
question is identified and the scale is balanced. During the investi- 
gation, facts are added to each side of the scale in the form of 
weights of varying sizes. The weight of a fact reflects its reliability, 
accuracy, and importance to the question at hand. At the completion of 
the information-gathering process, the evidence should support one 
alternative or another, and the decision can be made. 



-46- 



FIGURE 3A 
WEIGHING EVIDENCE 



Time frame 



Formulation of Decision 
Question 



End of Evidence Gathering Process 





No 



Yes 



No 



Yes 



Question 



Is there reasonable cause to believe that the father twisted and 
broke the child's arm (abuse)? 



Evidence 



fat her denies 
twisting and 
pulling of arm. 



°mother supports 
father's descrip* 
tion. 



°X-rays indicate 
spirals fracture 
of right forearm. 

°neighbor saw 
father twist 
child's arm. 

bruises on inside 
of child's arm. 



-47- 



FIGURE 3B 
ASSESSMENT OF RISK 



Receive Report 



Check Data » 



Contact Reporter 



Interview Child 



Observe Home 



Interview Caretaker 



Interview Siblings 



Interview Alleged Perpetrator 



Contact Physician 



Interview Neighbor 



Speak with Poll 



Consult SupervisoF 



Finding 




Assess Risk of Harm 



Assess Risk of Harm 



Assess Risk of Harm 



Assess Risk of Harm 



Assess Risk of Harm 



•Assess Risk of Harm 



Assess Risk of Harm 




Assess Risk of Harm 



Assess Risk of Harm 



Assess Risk of Harm 




Assess Risk of Harm 



Assess Risk of Harm 



Assess Risk of Harm 



-48- 



D. ASSESSMENT OF RISK 

"Assessment of risk (of harm)" is a label used for a process in which the 
social worker, in consultation with the supervisor, determines whether or 
not a child is safe and unlikely to be harmed by abuse or neglect in the 
near future. The assessment process is the focal point of the investigatiwn 
and- affects other investigative decisions and actions (refer to Figure 3B 
for a portrayal of this relationship ). Risk assessment should not be viewed 
as a one-time only determination, but rather as an ongoing evaluation which 
reoccurs each time a new piece of evidence is obtained and analyzed. 

Risk of harm to the child may be visualized on a continuum ranging from 2mm 
through intermediate to high risk. All children are "at risk" of harm from 
accidents, childhood diseases, random violence and caretaker-inflicted 
injuries. Normally, this risk is relatively low; it is unlikely that the 
child will suffer substantial harm. Accordingly, the social worker must 
focus on assessing the potential risk in terms of the likelihood that the 
responsible caretaker, through active or passive means, will harm the child 
so that his health/safety is endangered (refer to Figure 3C, below) 



FIGURE 3C 



RISK OF HARM 



Lower Risk 



Higher Risk 



* 



Normal child development and 
good oarenting abilities 



Abnormal child development and 
abusive /neglectful parenting 
abilities 



The relative level of risk to a child is determined from the evidence 
gathered during the investigation, an analysis of its reliability and 
importance, and an evaluation of how the facts interrelate. A number of 
factors have been identified which should be used to determine the risk 
to the child. Due to the interdependence of the factors, they have been 
categorized as follows: 

Child Factors 

age 

physical and mental abilities 
Caretaker Factors 

level of cooperation 

physical, mental, and emotional abilities /control 



-49- 



Alleged Perpetrator Factors 

rationality of behavior 

access to child 
. Incident Factors 

extent of permanent harm 

location of injury 

previous history of injury /neglect 

physical condition of home 
Environmental Factors 

support systems 

stress 

The preceding list contains select factors - those deemed as most important 
and most common in investigations. Other factors may merit inclusion in the 
assessment of risk; however, this chapter focuses on the most pervasive 
factors. 

The following discussion defines each factor, explains the theory upon which 
it is based, presents continuums used to illustrate the theory, and provides 
investigative examples to guide the social worker. 

The illustrative continuums used in the following sections present a variety 
of situations pertinent to each factor, ranging from lower to higher risk. 
The continuums are not designed nor intended to present all possible situa- 
tions, nor should the social worker regard them as rigid, inflexible tools. 
The information presented m this section is designed to help social workers 
make correct, carefully conceived, and timely decisions. It does not sub- 
stitute for or supercede investigative judgement. 

1. Child Factors 

Two factors focus on the capability of the child to withstand abuse or 
neglect and prptect himself. The age of the child has a direct bearing 
on the protection of the child and is highly interrelated with the 
child's physical and mental capabilities. A normal infant does not have 
the mobility, nor the verbal and reasoning abilities of a normal 15 
year-old which could be used for self -protection. 

a. Age 

The child's age is defined as his biological or chronological age - 
the length of time since birth. Generally, the younger the child: 



-50- 



the more vulnerable to abuse, neglect, and manipulation by the 
caretaker. A very young child is dependent upon the caretaker 
to provide nutrition, shelter, clothing, and affection, whereas 
an adolescent may be able to secure these items independently 
without the help of a caretaker. 

° the less able to protect himself from physical abuse or neglect. 
A secondary-school aged child can run away from physical abuse 
by leaving the home. The five-year-old can sometimes avoid a 
parent's anger by hiding in closets or behind chairs, or running 
out of the parent's way. Infants have no mobility and cannot 
protect themselves. Similarly, older children can cook and 
feed themselves, whereas a toddler cannot. 

the greater the potential harm will be from abuse or neglect due 
to the child's fragile physical condition. A blow to the soft 
skull of an infant may do substantial injury (e.g., subdural 
hematoma). The same blow to an adolescent's head may have less 
of a measureable physical affect. 

The continuum below presents examples of the range of ages in light 
of the potential risk to the child. 



FIGURE 3D 
AGE 



Lower Risk 



Higher Risk 



4- 



Intermediate Risk 



} 



Adolescent 
secondary 
school age 



Upper 

elementary 
school age 



Lower 

elementary 
school age 



Preschool 



Infant 



An illustration of a situation which represents lower risk of harm 
would be discipline of an adolescent during which the caretaker 
repeatedly shakes the child and pushes him against the wall. The 
adolescent may be emotionally upset, but there is little risk of 
permanent physical harm. The same treatment of a seven-year-old 
child will increase the risk of harm to the intermediate level. The 
younger child may suffer neck or head injuries as a result of the 
parent's action and may be bruised where the parent grabbed him 
(see Appendix C for physical /medical indicators of abuse and neglect), 
Given the same action, but an infant victim, the risk of harm 
becomes higher. The parent's action could easily result in severe 
neck injuries (whiplash, broken spinal column) and subdural hematoma. 



-51- 



b. Physical and Mental Abilities 

These factors refer to the child's abilities to care for and pro- 
tect himself and are obviously influenced by the child's chronolo- 
gical age (in addition to his mental age), in that physical abilities 
- talking, walking, eye-hand coordination - are acquired at certain 
ages. Children who are able to care for and protect themselves are 
less likely to be at risk of harm than children who do not have these 
abilities. 

On the other hand, some children, regardless of their age, are at a 
greater risk of harm than "normal" children, due to physical or 
mental handicaps. In "The Role of the Child in Abuse: A Review of 
the Literature", published in the American Journal of Orthopyschciatry 
(October, 1987), the authors examined conditions or factors present 
in children which put them at higher risk of abuse or neglect. 
These included: 

Mental retardation 

Physical handicaps 

Congenital abnormalities (missing limbs, fingers) 

Prematurity! 

Otber conditions which affect the child's ability to protect him- 
self or which increase his reliance on the parent include: 

Chronic illness (asthma, diabetes) 

Diseases affecting motor coordination (cerebral palsy, muscular 
dystrophy) 

Alcohol /drug addiction 

Finally, the authors cite research which indicates that a child who 
is "intellectually more capable than his parents..." 2 may be more 
vulnerable to abuse, although perhaps better able to protect himself. 

The continuum presented below illustrates the range of children's 
physical and mental abilities in light of risk of harm. The per- 
centages denote the approximate amount of adult assistance required. 

FIGURE Jf 
PHYSICAL AND MENTAL ABILITIES 



Lower Risk 



Cares for and 
protects self 
without adult 
assistance 
(0%) 



Requires a 
minimal 
amount of 
adult assis- 
tance to 
care for & 
protect self 
(25%) 



Intermediate Risk 



Requires adult 
assistance to 
care for and 
protect self 
(50%) 



Higher Risk 

> 



Unable to care 
for and protect 
self without 
substantial 
adult assis- 
tance (75%) 



Completely unable 
to care for or 
protect self with- 
out adult assis- 
tance (100%) 



-52- 



An example of lower risk of harm in light of the child's physical 
and mental abilities is a 10-year-old left unsupervised for 10 hours 
when the temperature inside the home is 40°F. An average 10-year- 
old can put on warm clothing, snuggle under the blankets, go to a 
neighbor's house, or cook food, if necessary. The side effects of 
the lack of heat and supervision may be minimal. If, however, the 
10-year-old is mentally retarded, the risk of harm may reach the 
intermediate level due to his inability to protect himself com- 
pletely from the cold. The result could be a minor illness such as 
a cold, or even influenza. The level or risk becomes higher if the 
child is handicapped to the extent that he is confined to a bed or 
wheelchair. Serious illnesses /conditions attributable to exposure 
to low temperatures could result in pneumonia, frostbite, etc. 

2. Caretaker Factors 

Two factors were identified which focus on the caretaker's role in 
assuring the safety and well-being of the child. First, the level of 
cooperation exhibited by the caretaker in protecting the child must be 
analyzed. This factor is related, in some degree, to the second, the 
caretaker's physical, mental, and emotional abilities /self-control. 
For example, a drug-dependent caretaker may be unable to cooperate with 
the investigator's efforts to assure the child's safety. Each of these 
factors is discussed below. 

a. Level of Cooperation 

"Cooperation" on the part of the caretaker is defined as willing- 
ness to take action to protect the child. Generally, the greater 
the degree of cooperation exhibited by the caretaker, the less 
likely it is that the child is at higher risk of harm. Such 
cooperation may include establishing and achieving protection-related 
goals by: 

availing himself of social services, including day care, private 
agency counseling, mental health treatment, Parents Anonymous, etc, 

initiating corrective action, such as cleaning the house, paying 
the utility bill to have the heat turned on, etc. 

Research indicates that the parent's reaction to the investigation 
and cooperation with the social worker have a significant effect on 
investigative decision-making. 3 The cooperation exhibited by the 
caretaker is dependent in part on his degree of understanding of the 
problem and how it may be resolved. This understanding may be 
reflective of the caretaker's mental abilities. Furthermore, care- 
takers may use cooperation with the social worker as a means of 
minimizing /easing the impact of the investigation, e.g., overly com- 
pliant caretakers may be manipulating the social worker and may not 
be as committed to the protection of the child as they would like to 
appear. The social worker should expect some hostility. The degree 
of hostility will affect the caretaker's willingness to cooperate in 
protecting the child. 



-53- 



The following continuum presents the level of cooperation exhibited 
by the caretaker from lower to higher risk for the child, 

FIGURE 3F 
LEVEL OF COOPERATION 



Lower Risk 



Intermediate Risk 



Higher Risk 



Aware of problem Not aware of Overly compliant Hostile, but will Does not 

* •■< >* it ■ i . • * i • A i mm j * • 



and works with 
social service 
agency to resolve 
problem and pro- 
tect child. 



problem, but 
works with 
social ser- 
vice agency 
to protect 
child. 



with social 
worker. 



work with social 
service agency as 
a result of court 
action. 



believe 
there is a 
problem; 
refuses to 
cooperate. 



A level of cooperation which illustrates lower risk to the child is 
represented by the caretaker who recognizes that a problem/ condition 
exists which threatens the child's safety, and who is willing to work 
with a social service agency or other apprppriate resources to 
resolve the problem. Arranging for day care between the end of the 
school day and the caretaker's return home from work is one example 
of .this behavior. In fact, this caretaker may be relieved at the 
Department's intervention and assistance with a recognized prpblem. 
An overly compliant caretaker represents an intermediate risk for 
the child. This caretaker's commitment to prptect the child is 
questionable, as he may be more concerned with minimizing the 
investigation's impact on himself than protecting the child. His 
voiced commitment to the child may be short-lived. Extreme hostili- 
ty to the point of threatening the worker or the child represents 
a higher risk of harm to the child. In fact, if Department inter- 
vention is initially unsuccessful, the caretaker may release his 
hostility and resentment for D5S involvement on the child. 

b. Physical, Intellectual and Emotional Abilities /Self -Control 

This factor represents the caretaker's ability tc protect the child. 
In theory , as the caretaker's intellectual, physical, and emotional 
functioning approaches average or above-average levels, the risk 
of harm to the child is correspondingly reduced. Individuals who 
are aware of the implications of their actions and who can con- 
sciously control their behavior are less likely to harm or neglect 
a child impulsively or with premeditation. 

Three components of the caretaker's functioning merit evaluation: 
physical, intellectual and emotional. Physical abilities may be 
assessed through observation of the caretaker. His mobility, 
flexibility, and dexterity should be observed for their effect on 
the physical ability to care for and protect the child through 
feeding, bathing, dressing, etc. Abuse of prescribed or illicit 
drugs may radically affect the caretaker's physical abilities as 
well as mental or emotional functioning. 



-54- 



Examples of behaviors and actions indicative of adequate intellect- 
ual functioning which serve to protect the child include: 

the ability to make judgments (reasoning) to protect the child 
from physical abuse or neglect or accidental injury 

the ability to plan the use of financial and personal resources 
to assure that the child has minimal levels of food, clothing, 
and shelter 

realistic expectations of the child's physical (motor), mental, 
language, and social development (see Appendix E) 

comprehension of the risk of harm to the child and initiation 
of appropriate corrective action 

awareness of time and location (Is the caretaker oriented to 
what is happening around him?) 

In order to analyze the caretaker's emotional functioning from the 
limited data available through interviews and observations of the 
interaction of family members, the social worker should consider 
the following: 

the caretaker's ability to control impulses of anger, hostility, 
physical violence, etc. 

the appropriateness of parent-child interactions (proximity, eye 
contact, touching, verbal exchange) - keeping cultural 
differences in mind 

the level of maturity demonstrated by the caretaker 

frequent and severe alterations of mood 

Finally, the social worker should consider physical and mental 
handicaps of the caretaker which impede his ability to care for the 
child. These may include mental retardation, mental illness, blinct- 
ness, chronic illness, etc. 

The range of variables contributing to the risk to the child is 
presented in the following continuum. 

FIGURE 3G 
PHYSICAL MENTAL AND EMOTIONAL ABILITIES /SELF-CONTROL 



Lower Risk 



Higher Risk 



<r 



Intermediate Risk 



Realistic expec- 
tations of child; 
can plan to 
correct problem. 



Unsure how to 
protect child, 
but able to 
assist in 
planning. 



Poor reasoning 
abilities; may 
be physically 
handicapped; 
needs planning 
assistance to 
protect child. 



) 



Unable 
to con- 
trol 

anger or 
impulses. 



Poor conception 
of reality, or 
severe mental or 
physical impair- 
ment. 



-55- 



An examole of lower risk is the caretaker whose live-in paramour has 
sexually molested her twelve-year-old son in the past during the 
caretaker's absence. The caretaker forces the perpetrator to leave 
the home and secures an order of protection to prevent further con- 
tact with the child, A working caretaker who exhibits poor judg- 
ment by leaving a four-year-old at home without supervision, and 
who may recognize' the need for day care but does not know how to 
secure that service, represents an intermediate risk to the child. 
A mentally ill caretaker who has an inadequate conception of reality 
and who does not recognize the child's need for food and affection 
represents a higher risk to the child. 

J. Alleged Perpetrator Factors 

Two major factors in the assessment of risk are associated with the 
alleged perpetrator of the incident: rationality of the alleged perpe- 
trator's behavior, and his access to the child. 

a. Rationality of Behavio r 

The rationality of the alleged perpetrator's behavior is defined as 
reasonableness of his action in light of the circumstances which led 
to the incident. In other words, was his action an appropriate 
response designed to protect the child and/or administer corrective 
action to improve the child's behavior? Given the timeframe of the 
investigation, the social worker cannot undertake a sophisticated 
analysis of the alleged perpetrator's motive. Rather, the presence 
or absence of certain variables provides clues to the rationality of 
the action. The foundation for the variables is the belief that if 
the act is reasonable, less harm will be incurred by the child. 
Conversely, the more deliberate or willful an act, the greater the 
risk to the child. For example, it is not reasonable to break a 
child's arm for spilling a glass of milk. 

The questions which the social worker should consider in analyzing 
the alleged perpetrator's behavior focus on the rationality or 
irrationality of his actions: 

Was the action taken as a disciplinary measure to correct 
inappropriate child behavior, or was the harm a result of the 
caretaker's desire to inflict injury and pain? 

What was the method used to inflict the harm? Was a weapon/ 
instrument used? The type of weapon used may reflect the 
reasonableness of the alleged perpetrator's action - a wooden 
baseball bat, for example, should never be used. 

How long did the discipline /action take? Did the alleged perpe- 
trator confine the child to his room for two hours or two days? 

Was the action appropriate to the child's age? The spanking of 
a two-month-old infant will not correct undesirable behavior. 

What is the location of the injury? 

-56- 



Was the harm a result of an accidental rather than a purposeful 
Injury? 

Is there a history of abuse or neglect of the child? For 
example, has the child been left unsupervised on previous 
occasions? 

The continuum below illustrates the range of variables associated 
with the alleged perpetrator's behavior. 



FIGURE 3H 
RATIONALITY OF BEHAVIOR 



Lower Risk 
(Rational ) 

< 



Intermediate Risk 



Higher Risk 
(Irrational ) 



) 



Accidental 
injury; 
adequate 
suoervision, 



Accidental 
injury; 
lack of 
supervision. 



Minor injury result - 
from excessive corpo- 
ral discipline. 



Inappropriate 
weapon used 
to harm child. 



Injury the 
result of 
desire to 
permanently 
harm child. 



Lower risk of future harm to a child is likely when a caretaker 
opens a door and accidentally hits a child standing behind it. Al- 
though a bloody or broken nose may result, the injury was uninten- 
tional. If however, the injury to the child was the result of an 
excessive disciplinary act, e.g., bruised knees from kneeling for 
three hours, the level of risk increases to the intermediate level. 
An example of higher risk of future harm is that of a caretaker who 
purposely inflicts pain or injury in order to cause permanent damage, 
such as a three-inch scar on the child's forehead. 

b. Access to the Child 

This factor is defined as the alleged perpetrator's ability to be 
close enough to the child to cause harm through passive or active 
means. The theory is that the greater the access to the child, the 
more likely it is that harm will occur. Variables which affect the 
alleged peroetrator's access to the child include: 

relationship to child (father, mother, grandparent, paramour of 
parent ) 

physical location of the alleged perpetrator 

ability to gain access to the child outside the home 

caretaker and family's willingness to protect or care c or the 
child 

° relationship of the alleged perpetrator to the child's caretaker 
(friend, lover, spouse) 



-57- 



The range of variables associated with this factor are presented in the 
following continuum: 

FIGURE 31 
ACCESS TO CHILD 



Lower Risk 



Intermediate Risk 



Out of home, 
no access to 
child. 



Out of home, 
difficult access 
to child. 



In home, access 
to child is 
difficult. 



Out of home, 
easy access 
to child. 



Higher Risk 

> 



In home, com- 
plete access 
to child. 



A child is at lower risk of harm when the alleged perpetrator has been 
removed from the home and denied contact with the child by the care- 
taker. A court order of protection is further demonstration of the 
caretaker's ability to protect the child and the alleged perpetrator's 
inability to gain access to him. If the alleged perpetrator remains 
in the home, but the child's grandmother has agreed not to let him 
remain alone with the child, the risk of harm reaches the inter - 
mediate level. A child is at higher risk of harm if the stepfather 
who abused him is left alone to care for him on several subsequent 
occasions. 

4. Incident Factors 

Four factors relate to the severity of current or previous incidents 
and their effect on the risk to the child: 

extent of permanent harm 

location of the injury 

previous history of abuse/neglect 

physical condition of the home 

The rationale for the selection of these factors is the belief that the 
severity of the injury is a reflection of the caretaker's ability or 
inability to protect the child. Thus, if a child is severely injured or 
ill due to extreme neglect, the likelihood that future harm will occur 
is high. Indicators of the severity of the child/abuse neglect incident 
will help the social worker assess the risk of harm to the child. 

a. Extent of Permanent Harm 

"Permanent harm" is defined as disfigurement observable to the naked 
eye and I or loss or impairment of a bodily function. In some in- 
stances, the disfigurement may be relatively minor - such as a one- 
quarter inch scar. In other cases, however, the disfigurement could 
be the loss of a finger, which also results in impairment of a 
bodily function. Accordingly, it is important to assess the extent 
of the injury /condition and its impact on the child's functioning. 
The greater the extent of the permanent harm, the more likely the 
child's health and safety will be jeopardized. 



-58- 



The continuum below presents a range of in juries /conditions from lower 
to higher risk. 



Lower Risk 



<- 



FIGURE J J 
EXTENT OF PERMANENT HARM 



Intermediate Risk 



Abuse/neglect Abuse/neglect 



Higher Risk 

> 



has no dis- 
cernible 
effect on 
child. 



limits child ' s 
participation 
in normal 
social 
activity. 



Abuse /neglect Abuse /neglect 

results in produces 

physical injury readily obser- 

discomfort, no vable perma- 

medical atten- nent injury, 
tion needed. 



Abuse /neglect 
results in 
death or perma- 
nent dysfunc- 
tion of an 
organ or limb. 



A 10-year-old child left unsupervised for four hours, who does not 
suffer any harm as a result of this situation, is at lower risk of 
future harm. If the same child was disciplined by his parent so 
that bruises appear on this buttocks, but no medical attention was 
required, he is at an intermediate risk level. The child who is 
blinded by acid thrown at him by the caretaker has suffered great 
permanent damage and is at higher risk for future harm. 

b. Location of the Injury 

The location of the observable or nonobservable injury or condition 
(disease, infection) is an important clue to the future risk of harm 
to the child. "Location" refers to the part of the child's body 
which has been directly affected by child abuse and neglect. Some 
areas of the child's body are more vulnerable to permanent damage 
than others - for example, the head (particularly the face), neck, 
genitals and lower back. Other areas, such as the buttocks and 
torso, are able to absorb more shock and abuse. Organ dysfunction 
or disease resulting from neglect may affect various areas of the 
child's body depending upon the type of neglect (malnutrition, 
filthy home, exposure to cold). Injuries in the more vulnerable 
areas indicate a higher degree of potential risk to the child. A 
caretaker who would inflict injuries on these areas of the body 
probably has poor impulse control. 

The range of injuries associated with lower to higher risk is depicted 
on the following continuum: 

FIGURE 3K 
LOCATION OF THE INJURY 



Lower Risk 



Intermediate Risk 



Higher Risk 

> 



Bony body parts: 
knees, elbows, 
buttocks 



Extremities, 
fleshy part of 
arms and legs 



Torso 



Internal 
injury 



Head, face and 
and genitals 



-59- 



Knees or legs (shins) are typical sites for childhood accidental 
injuries. Trauma to these parts of the body is rarely life-threaten- 
ing. Accordingly, there is a lower risk of harm associated with 
these injuries. Cuts, bruises, and burns to the child's torso are 
more severe - intermediate level - as they could affect internal 
organs and bodily functions. The highest risk of harm is present 
when a child has suffered facial or head injuries such as blindness, 
subdural hematoma, etc. 

c. Previous History of Child Abuse or Neglect 

Prior reports of child abuse or neglect that were supported may 
involve the current reported child or his siblings. In addition, if 
the alleged perpetrator was involved in a previous report of abuse/ 
neglect that was supported, even with different child subjects, 
this should be noted. The theory behind the inclusion of this factor 
in the assessment of risk is that, if a child has been abused on one 
or more previous occasions, the likelihood of future abuse is higher. 
Such incidents demonstrate the caretaker's consistent inability to 
protect the child. 

The existence of a previous report, however, does not necessarily 
indicate a higher degree of risk. The social worker must consider: 

the number of previous incidents 

, the type of previous incidents 

if the abuse/neglect has escalated in severity over time 

if only one child is continually abused or if all children are 
abused /neglected indiscriminately 

This factor is one of the few which does not rely on the investiga- 
tor's analysis of the current incident. It therefore provides a 
more objective tool which workers can use in combination with the 
more subjective assessments which must be performed. 

The factor continuum below demonstrates the range of prior histories 
which may be included in the social worker's assessment of risk. 

FIGURE JL 
PREVIOUS HISTORY OF CHILD ABUSE OR NEGLECT 

Lower Risk Higher Risk 

/ Intermediate Risk v 

No previous, Previous neglect Previous neglect Previous abuse Previous abuse 
reported of siblings. of child. of siblings. of child, 

history of 
abuse /neglect. 

A lower level of risk to a child would be no previous reported his- 
tory of indicated abuse or neglect. An intermediate level of risk 
occurs when a child or sibling has been the subject of previous 

-60- 



indicated reports of child abuse /neglect, but the allegations in- 
volved were cuts, bruises, welts, or educational neglect, etc. If 
the child was the subject of a prior report and if that report con- 
tained allegations such as sexual abuse, subdural hematoma, or 
internal injuries, the child is at higher risk of future harm. 

d. Physical Condition of the Home 

The condition of the house, apartment, trailer, etc., may be the 
reason for the initial report to the Department. A home which does 
not protect the child from such potential dangers as weather ex- 
tremes, rodents, accumulated trash /garbage, filth, etc., poses a 
risk of harm to the child. The safer the home, based on its con- 
struction and general cleanliness, the less the risk to the child of 
accidental injury or disease caused by unsafe or unhealthy conditions. 

A constellation of variables is used to assess the adequacy of a 
home in protecting a child. The variables which may impinge upon 
this determination are listed later in the section; however, first 
a word of caution is appropriate. 

A condition of the home must be viewed in the context of at least 
four other factors: 

age of the child and his siblings 

, financial resources of the caretaker 

attempts by the caretaker to correct the problems (insects, 
rodents, leaks, etc. ) 

season of the year 

These variables, in light of the preceding conditions, may affect 
the social worker's decision. For example, lack of a heating system 
is not a problem during the summer. Although a home may be roach 
infested, if the caretaker has unsuccessfully attempted to correct 
the problem and has taken measures to alleviate the harm, the social 
worker may view those conditions differently from those of the child 
whose caretaker has made no such attempts. 

The variables to consider include: 

condition of plumbing and availability of running water 

structural soundness of the building 

wiring - exposed or hidden 

cleanliness of the home (absence of garbage, trash, animal 
droppings, etc. ) 

availability of heat during the winter 



-61- 



Lower Risk 



<r 



The continuum for this factor is as follows: 

FIGURE JM 
CONDITION OF THE HOME 



Intermediate Risk 



Higher Risk 



Home is clean Dirty home, some 
with no appa- accumulated gar- 
rent safety or bage, mold grow- 
health ing on dirty 
hazards. dishes. 



Trash and gar- 
bage not dis- 
posed, animal 
(pet) drop- 
pings in home, 



Unsound steps 
exposed wiring 
urine-soaked 
mattresses. 



Structurally 
unsound, 
leaky roof 
and windows, 
walls bend- 
ing under 
weight, hole 
in exterior 
walls. 

An example of a home which poses a lower risk of harm to the child 
is one which is clean, with no apparent safety hazards such as 
exposed wiring or rodent infestation. Accumulations of several 
weeks worth of trash and garbage in uncovered containers, and animal 
droppings may pose a health /disease hazard for the child and thus 
represents an intermediate level of risk. A home with gaping holes 
in the walls, broken windows, leaky roof, exposed wiring, and no 
heat presents higher risk of harm to the child. 

5. Environmental Factors 

Two factors were identified which affect the risk to the child as a 
result of external conditions: 

support systems 

stress 



a. Support Systems 

The category of "support systems" is defined as the presence of indi- 
viduals, agencies, professionals, or other resources that can help 
the caretaker protect the child, particularly during a personal or 
family crisis. Support systems include individuals outside the 
child's home and immediate family. Examples of possible resources 
are: 

relatives 

friends /neighbors 

local mental health agency 

religious organization 



-62- 



self-helD groups such as Parents Anonymous 

social service agencies 

medical clinic - hospital social services staff 

law enforcement officers 

If a caretaker is able to call upon a wide variety of resources to 
provide assistance in nurturing and disciplining a child, parti- 
cularly when a family crisis occurs (e.g., hospitalization, unemploy- 
ment, spouse incarcerated ), then the risk to the child is lower . 
This judgment, however, is predicated upon the caretaker's ability 
and willingness to avail himself of these resources. 

Caretakers who have few friends, no relatives in the vicinity, and 
limited community resources may not have the assistance necessary 
to protect the child. Rural communities and geographically isola- 
ted families may have few resources to call upon. 

The continuum below depicts the range of possible external support 
systems and their impact on the risk of harm to the child. 

FIGURE 3N 
EXTERNAL SUPPORT 



Lower Risk 



Higher Risk 



4- 



Intermediate Risk 



Family, 
neighbors, 
and friends 
available; 
good com- 
muni ty 
resources. 



Limited community 
resources; family 
and friends avail- 
able. 



Family supportive 
but not in geogra- 
phical area; some 
support from 
friends. 



Little support 
from family or 
friends - no 
communi ty 
resources . 



Caretaker/ 
family has 
no rela- 
tives and 
geographi- 
cally iso- 
lated from 
communi ty 
services. 



A caretaker who has close relatives within one hour's driving dis- 
tance and numerous friends and neighbors will be able to draw upon a 
variety of supportive individuals during difficult periods. In a 
large town, community resources, religious organizations, and 
schools can provide support. Thus, the risk to the child is lower . 
If the caretaker has few friends, no relatives in the area, and 
limited contact with other community members, sufficient external 
support may not exist, causing an intermediate risk to the child. 
The instance of a rural family 30 miles from the closest town, with- 
out reliable transportation, two miles from their nearest neighbor 
and with no neighbors in the vicinity may present a higher risk of 
future harm to the child. 



-63- 



b. Stress 



Events or situations which precipitate change, either pleasant or 
unpleasant, may create stress and may necessitate adaptive behavipr. 
Life crisis or stress has been identified as a contributing factor 
to abuse/neglect of children. 4 The premise is that the greater the 
number of major life changes, the less able a person will be tp cope 
with his environment and the more likely it is a child will be 
harmed. Examples of changes which substantially affect a person's 
ability to cope with average daily problems are (in order of magni- 
tude): 

death of a spouse 

di vorce 

jail term 

marriage 

unemployment 

change of career 

change of residence 

■ vacation 

The degree of the stress (death of sppuse versus vacation) as well 
as the number of changes occurring at one time must be considered. 
A man whose wife divorces him, leaving the children in his care, 
and who loses his job within the same month is under roughly as much 
stress as a man whose wife dies. 

Analysis of the impact pf stress on incidence of abuse and neglect 
is a relatively new field of research; accordingly social workers 
should carefully analyze the use of this factor in their assessment 
of risk to the child. Factors such as age and location of the 
injury which are supported by empirical research should be given 
greater weight. 

The continuum below illustrates some examples of the range of chan- 
ges which affect the caretaker's ability to prptect the child(ren). 

FIGURE 30 
STRESS 



Lower Risk 



<r 



Intermediate Risk 



Higher Risk 

> 



Stable family, Trouble at Birth of 

steady employ- work, change child 

ment, nonmobile of residence 



Incarceration of Death of 

family member, or spouse 
di vorce 



-64- 



A family which has resided in the same home for five years, in 
which both parents have been employed for 10 years in their respec- 
tive companies, and who have been married for 20 years represent a 
stable environment and a lower risk to the child. An intermediate 
level of risk is present in a family into which a child is born - 
this may be a pleasant or unpleasant (e.g., an unwanted child) 
experience, yet generates stress in either situation. The death of 
a spouse or immediate family member presents a higher risk of harm 
to the child, particularly in a family which was only marginally 
able to cope with daily problems. 

6. Factor Matrix 

The preceding discussion of factors used to assess risk is summarized 
in Table 3A entitled "Assessment of Risk - Summary Factor Matrix." 
Each factor is presented with corresponding examples of lower, inter- 
mediate and higher risk to the child. This table may be used in the 
investigation prior to the determination of risk. 

Thorough analysis of the table provides several guidelines which the 
social worker may use in assessing risk throughout the investigation. 
These guidelines are: 

Generally, if five factors are rated at the higher risk level, 
sufficient overall risk probably exists to provide emergency 
services to the child. 

If four factors are adjudged to be higher risk , careful considera- 
tion should be given to providing emergency services; in the 
majority of cases the overall risk of harm may be sufficient to 
justify the provision of emergency services. 

If five factors are assessed at the lower risk level, emergency 
services are not generally appropriate. 

Most decisions will be less clear-cut, and the social worker must 
apply skills, education, and experience to determine the level of risk 
of harm to the child. As this evaluation is the most significant 
activity during an investigation, consultation with the supervisor 
is highly recommended. 

To illustrate the use of the factors and the summary matrix in assess- 
ing the risk of harm to the child, two simplified examples have been 
formulated. These examples contain all investigative factors but do 
not reflect all the gradations of risk that may be present in an 
investigation. Therefore, investigators should be cautious in the 
application of these examples to actual investigations. A further note 
of caution: not all of the factors discussed will be present in every 
investigation. 

EXAMPLE - SCHROEDER FAMILY 

The following facts pertain to the investigation of the alleged abuse 
of Johnny Schroeder by his father. The levels of risk associated with 
each fact are present. 



-65- 



TABLE 3A 

assessment of risk 
summary factor matrix 



FACTORS 


LOVER RISK 


INTERMEDIATE RISK 


HIGHER RISK 


1. Child's Age 


Adolescent 


Lower elementary school age 


Infant 


2. Child's Physi- 


Cares for and pro- 


Requires adult assistance 


Completely unable to care 


cal & Mental 


tects self without 


to care for and protect self 


for or protect self with- 


Abilities 


adult assistance 




out adult assistance 


3. Caretaker's 


Aware of problem, 


Overly compliant with 


Doesn't believe there is 


Level of 


works with social 


investigator 


a problem, refuses to 


Cooperation 


service agency to 
resolve problem and 
protect child 




cooperate 


4. Caretaker's 


Realistic expecta- 


Poor reasoning abilities, 


Poor conception of reality 


Physical, Men- 


tions of child, can 


may by physically handicap- 


or severe mental or 


tal & Emotional 


plan to correct 


ped, needs planning assis- 


physical handicaps 


Abilities/Con- 


problem 


tance to protect child 




trol 








5. Rationality of 


, Accidental injury, 


Minor injury resulting from 


Injury the result of 


Alleged Per- 


adequate supervision 


excessive corporal disci- 


desire to harm the child 


petrator's 


(rational ) 


pline 


permanently (irrational) 


Behavior 








6. Alleged Per- 


Out of home, no 


In home, access to child 


In home, complete access 


petrator's 
Access to 
Child 


access to child 


is difficult 


to child 








7. Extent of Per- 


Abuse/neglect has no 


Abuse/neglect results In phy- 


Abuse/neglect results in 


manent Harm 


discernible effect 


sical injury/discomfort, no 


death or permanent dys- 




on child 


medical attention needed 


function of an organ or 
limb 


8. Location of 


Bony body parts 


Torso 


Head, face, genitals 


the Injury 


(knees, elbows), 
buttocks 






9. Previous His- 


No previous reported 


Previous abuse/neglect of 


Previous abuse/neglect of 


tory of Abuse/ 


history of abuse/ 


child 


child 


Neglect 


neglect 






10. Physical Con- 


Home is clean with no 


Trash and garbage not dis- 


Structurally unsound. 


dition of the 


apparent safety or 


posed, animal droppings in 


leaky roof and windows. 


Home 


health hazards 


home 


wall bending under weight, 
holes in exterior walls 


11. Support System 


Family, neighbors, 


Family supportive but not in 


Caretaker/family has no 




friends available; 


geographic area; some support 


relatives or friends and 




good community 


from friends 


is geographically isolated 




resources 




from community services 


12. Stress 


Stable family, steady 


Birth of child 


Death of spouse 




employment, nonmobile 


-66- 





Facts 



Risk Level 



Johnny is ten years old. 

Johnny requires some adult assistance in preparing 
food and cleaning his room. 

Mr. Schroeder admits that he hit Johnny harder than 
he should have, and he has talked to a counselor. 

Mr. Schroeder realized Johnny's limitations and appears 
to have reasonable expectations of his abilities. 

Mr. Schroeder hit Johnny while disciplining him for 
not doing his chores. 

Johnny and his father live in the same house. 

The blow to Johnny left him breathless and sore for 
several hours, but otherwise had no discernable effect. 

Johnny was hit in the abdomen. 

There is no previous history of child abuse or neglect 
for any of the subjects of the current report. 

The Schroeder home is structurally sound and contains 
no health or safety hazards. 

There is a limited amount of community support avail- 
able and the Schroeders have a few friends. The 
neighbors are not particularly friendly. 

There is a limited amount of stress created as a 
result of the incident and the investigation. 
Mr. Schroeder has coped well with the situation. 



Intermediate 
Intermediate 

Lower 

Lower 

Intermediate 

Higher 
Lower 

Intermediate 
Lower 

Lower 

Intermediate 



Lower 



The outcome of this analysis is that the risk of harm to Johnny is in 
the lower to intermediate range and certainly does not warrant emergency 
services or removal. 

EXAMPLE - ROBINSON FAMILY 

The following facts pertain to the investigation of the alleged abuse 
of Susie Robinson by her cousin who lives with the Robinsons, and the 
alleged neglect of Susie Robinson by her mother for leaving her with an 
inappropriate caretaker. The levels of risk associated with each fact 
are presented. 



Facts 



Susie is 18 months old. 



Susie is unable to care for or protect herself. 

Susie's mother is aware of the abuse but is not sure 
what she can do to protect Susie in the future. 



Risk Level 
Higher 
Higher 
Intermediate 



-67- 



Robinson Family (continued ) 

Facts 

Mrs. Robinson does not have realistic expectations of 
her daughter's abilities but is able to undertake 
some planning to assure her safety. 

The injury resulted from excess corporal punishment 
inflicted by the cousin to quiet Susie while her 
mother was at work. 

The cousin remains in the home, and Mrs. Robinson 
does not want her to leave. 

The punishment resulted in a subdural hematoma as 
the cousin hit Susie and knocked her against the wall. 

The subdural hematoma was located on the back of 
Susie's head. 

The cousin was reported three months previously for 
bruises on Susie's back. 

The Robinson home is only marginally clean. Trash and 
garbage are not oroperly disposed. 

The Robinson family does not seem willing to help 
Mrs. Robinson protect Susie from further harm. 
Mrs. Robinson has a few friends. 

Mrs. Robinson is having problems at work, particularly 
with a recent shift change. She is unable to cope 
with the investigation. 



Risk Level 
Intermediate 



Intermediate 

Higher 

Higher - 
Intermediate 

Higher 

Intermediate 

Intermediate 



Intermediate- 
Higher 

Intermediate- 
Higher 



The child could be removed from the home. However, this should be con- 
sidered only after Mrs. Robinson has refused In-Home Services (i.e., 
homemaker, visiting nurse, etc. ). 

7. Summary 

Assessment of the risk of harm to the child is the most important facet 
of the investigation. Failure to meet this responsibility thoroughly 
may jeopardize the child's safety and will affect the quality of 
decisions made which rely upon the assessment of risk as a major 
decision criterion. 

Accordingly, analysis of the investigation in light of the factors just 
discussed will be beneficial in: 

assuring all facets of the decision-making process are considered 

structuring the gathering of information to assess the factors 

providing a measure of uniformity in decision-making 

assuring that the focus of the investigation is protecting the child 



-68- 



E. INVESTIGATIVE DECISIONS 

There are several major questions to be answered in a child abuse /neglect 
investigation: 

Is an emergency response necessary? 

Are emergency services needed? 

What is the investigative plan? 

Should law enforcement assistance be involved? 

Should the legal counsel be involved? 

Is the investigation complete? 

Is there reasonable cause to believe there is/has been abuse or neglect? 

Each decision depends upon the assessment of potential risk of harm to the 
child, which is determined by analysis of specific factors. One might argue 
that the repeated assessments of risk which directly affect the decisions 
above are the only investigative decisions made by workers. However, such 
simplification does not help the worker understand the actions required dur- 
ing an investigation and ignores the fact that correct decisions are the 
result of a convergence of proper investigative techniques, adequate docu- 
mentation, , accurate weighing of evidence, and assessment of risk. 

Appropriate techniques guide the social worker in determining the amount of 
information necessary and the methods of gathering it. Adequate documenta- 
tion assures that evidence is properly organized and preserved. Weighing" ^ 
the evidence enables the social worker to evaluate its reliability and 
relative importance. Each of the preceding activities involves skills 
required to assure thorough investigations and sound decisions. For example, 
if a social worker does not have reliable, complete information, has focused 
on erroneous statements rather than correct information, or does not under- 
stand what factors are necessary to assess risk of harm, the decision on 
the need for emergency services will be flawed. 

1. Emergency Response 

The decision to intervene immediately is based on the perceived risk of 
harm to the child and may occur in certain situations as a result of 
information obtained from the reporter. This decision may initially be 
made by the social worker in consultation with the supervisor, but 
should be reevaluated throughout the investigation as new data is 
recei ved. 

An emergency response should be considered upon receipt of a report when: 

° a child is believed to be in immediate danger of physical harm 

a child is believed to be abandoned 

it is likely that the family may flee or the child cannot be 
located for other reasons 



-69- 



The following three factors may warrant an immediate response, in 
addition to the preceding three. 

a. Location of the Child 

A child may be protected by virtue of his location and therefore not 
require immediate action. That is, if resources exist in his cur- 
rent environment which protect him from further harm, an emergency 
response may be unnecessary, although periodic review of the child's 
location must be carried out to verify that it continues to provide 
protection. Hospital stays leading to eventual discharge, visiting 
relatives who can prptect the child but who cannot stay indefinitely, 
and day care centers represent examples pf tempprary "safe" situa- 
tipns. 

b. Existence cf Majpr Family Crisis 

Families in crisis situations frequently are unable to protect their 
children. Incarceration of the caretaker increases the possibility 
that the child will not receive proper care, as does emergency 
hospitalizatipn pf the caretaker without pripr arrangements fpr 
child care. If such a situatipn is likely to occur during an investi 
gation, it should be monitored since immediate intervention could be 
required. 

c. All Majpr Actors in One Location 

If the family of an abused child is together at the pplice station, 
an emergency resppnse may not necessarily be required; the police 
can protect the child. Nonetheless, the investigatpr may determine 
that this is the most appropriate time to get information from and 
offer assistance to the family or the pplice. In this case, an 
emergency response may be apprppriate. 

2. Emergency Services (See Summary Factor Matrix) 

The provision of emergency services is the only oppprtunity the spcial 
worker has to take action to meet the immediate needs of the child. The 
decision to prpvide such services cannot be taken lightly, as it can 
literally be a matter pf life and death. The emergency service decision 
is based upon the assessment pf risk tp the child and must be reassessed 
frequently. As the level of risk increases, sp does the likelihood of 
a need for emergency services. Emergency services consist of, but are 
not limited to: 

removal of the child from his home (prptective custcdy), followed 
by relative or non-relative placement 

rempval pf the alleged perpetrator 

in-home services (e.g., homemaker) 



-70- 



The emergency service is provided in light of the child's needs. 

Removal of the alleged perpetrator from the home can be accomplished 
through either police/court intervention or voluntary departure. 
This option is successful only when the caretaker cooperates. 
Factors 3 and 4 must be at the intermediate to lower range on the 
scale to assure the success of this option. Obviously, the 
responsible caretaker and the alleged perpetrator must be different 
individuals; therefore, this option is recommended when factors 5 and 
6 are high. 

The type of in-home services available varies from region to region, 
but most often includes homemaker and counseling services. In-home 
services are recommended when the risk of harm is attributable to 
acts of omission (neglect), e.g., factors 9 (previous history), 10 
(condition of home), and 11 (support systems). Higher risk in these 
factors suggests the appropriateness of in-home services. 

Removal of the child from his home is the most extreme emergency 
service and should be considered when five or more factors indicate 
higher risk. This option is specifically related to factor 1 
(child's age) through 7 (location of injury) on the factor matrix. 
When five of the seven are assessed as higher risk, removal is 
generally indicated. 

3. Investigative Plan 

The investigative plan must continually be reevaluated as new data is 
obtained. Frequently, a plan of action must be developed on the spur of 
the moment. At other times, however, it can be considered, discussed 
with the supervisor, and fully evaluated before it is carried out. 
Such is the nature of the investigative process. For example, the 
alleged perpetrator can either be cooperative or refuse to speak with 
the social worker and /or allow him to see the child. In the latter 
situation, the investigator must decide whether to request police 
assistance or to return at a later date. This decision has a signifi- 
cant effect, not only on the facts obtained, but on the Department's 
future relationship with the family, and should be done with supervi- 
sory input. Fortunately, the investigative plan can generally be 
developed in advance. The strategy chosen should be based upon the 
social worker's assessment of risk to the child, with consideration of 
the most effective and efficient use of the social worker's time. The 
plan should reflect analysis of the following: 

the information required 

location of information 

sequence of interviews 

location of interviews 

techniques of collecting information 



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a. Information Required 

The social worker should determine what information is required to 
assess the risk of harm to the child and develop the plan according- 
ly. The information required will vary with specific situations; 
however, the plan should include an information flow which will 
assure that objective information is obtained and that subjective 
information is corroborated. 

b. Location of Information 

Having determined what information is needed, the social worker must 
identify corresponding information sources. Who will be contacted 
is determined in part by the report, and by the type of information 
needed. For example, to document the extent or cause of an injury, 
the social worker should schedule a physical examination by a 
physician. If a criminal background check on an alleged perpetrator 
is warranted, the police may be contacted. Often decisions about 
whom to interview will be made as new facts are uncovered - one 
interview may be the key to identifying other sources of informa- 
tion. In contrast, when sources cannot supply anticipated informa- 
tion, the social worker should expand the list of interviewees until 
all necessary data is obtained. 

c. Sequence of Interviews 

Often, critical knowledge is necessary prior to key interviews. The 
order in which individuals are contacted and interviewed may help 
formulate questions and evaluate responses in later interviews. For 
example, a caretaker may explain that a child's severe injury is the 
result of a fall. Without previous contact with a physician, the 
social worker may not be able to question the plausibility of the 
explanation. However, had the child been examined by a physician 
prior to the interview of the caretaker, the social worker may be 
able to ask additional questions to evaluate the accuracy of the 
explanation. 

d. Location of Interview 

The social worker must consider the appropriateness of the interview 
setting. In many instances, the amount of information given will 
relate directly to the location of the interview and who is present. 
Accordingly, the impact of the location on the interview should not 
be underestimated. For example, interviewing a child in a non- 
threatening setting, apart from the alleged perpetrator, may improve 
the quality and quantity of information obtained. 

e. Techniques of Information Collection 

The social worker must determine what information-gathering techni- 
ques are most appropriate for a specific investigation, There are 
many techniques at the investigator's disposal, including inter- 
views, observation, medical examinations, and x-rays. Each technique 
has a potential benefit. 



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4. Police Involvement 

The social worker in consultation with the supervisor must decide If it 
is necessary to involve (or contact) the local police department during 
the investigation. Assistance from policy should be considered if: 

■ ° the social worker has been denied access to the child 

assistance is needed to locate subjects of the report 

the worker is at risk of harm 

assistance is needed in taking protective custody 

5. Investigation Completeness 

The social worker should review and evaluate the information collectsd 
to determine if: 

contradictory information exists 

the credibility of a subject or collateral is suspect 

information from one source can be corroborated or refuted by 
another 

information collected is sufficient to support major decisions 

These situations will become evident through careful review of the zteta- 
The social worker must then determine the necessity of obtaining 
additional information which may require: 

re-interviewing of subjects 

interviewing additional collaterals 

gathering physical evidence 

making observations 

f\ basic investigative rule is that it is better to conduct one interview 
too many than one too few. The social worker should always assure that 
the investigation is complete. 

6. Reasonable Cause 

The last major decision during an investigation is to determine whether 
or not there is reasonable cause to believe that abuse and/or neglect 
exists. Reasonable cause is defined as that collection of facts which* 
when viewed in light of surrounding circumstances, would cause a 
reasonable person to believe that abuse or neglect occurred. In enter 
to determine if reasonable cause exists, the social worker weighs the 
reliability of and ascribes importance to each piece of information. 
Reducing the information to statements of fact and source helps the 
social worker with this process. For example: 



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alleged perpetrator denies injuring the child (interview ) 

mother states father did not injure the child (interview) 

physician reports injury could be the result of abuse (medical 
record, interview) 

The social worker may envision the process of evaluating evidence and 
making decisions as a scale or ledger sheet. Each is constructed with 
the facts supporting the allegation on the right and those refuting it 
on the left. By so distilling the information, you can readily find the 
critical evidence and apply the "reasonable" person standard. 

Two examples are delineated on the following pages. 

EXAMPLE 1 - THE WILLINGHAMS 

Mrs. Willingham brought her ten-year-old son Edward to the hospital 
emergency room with complaints of dizziness and a severe headache. The 
condition was attributed to a fall from a tree. The examining physician 
telephoned the Department alleging possible child abuse. The alleged 
perpetrator was identified as Mr. Willingham. 

The social worker assembled the following facts: 

1. Fact: Child has a fractured skull. 



Evidence: 



2. Fact: 



Evidence. 



3. Fact: 



Evidence. 



4. Fact: 



Evidence. 



5. Fact: 



Evidence. 



Physician's diagnosis (medical report); x-rays 

Physician states injury could be the result of abuse. 

Physician 's statement-interview 

Alleged perpetrator (father) denies injuring the 
child. 

Interview with father, who claims he was playing 
golf at the time of the incident and who readily 
gave the name of his golf partner. 

Mother stated that the father did not injure child. 

Interview with child's mother - Mrs. Willingham 
stated that her husband was playing golf with a 
friend when Edward fell from a tree. Edward was 
playing with a friend when he fell. 

Child denies that his father injured him. 

Interview with child - Edward stated that he fell 
from a tree and hit his head on the ground. His 
father was not present when the incident occurred. 



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Fact: 
Evidence: 



Fact: 



Evidence: 



Neighbor reports seeing the father hit the child 
with a large stick. 

Interview with neighbor - Mrs. Bower stated she does 
not like the Willinghams or approve of the way they 
are raising Edward. She stated she saw Mr. Willing- 
ham hit Edward on the head with a large stick. 

Friend of the victim states child fell from the tree. 

Interview with child's friend - Both children were 
climbing a tree in the Willingham's backyard when 
Edward slipped and fell to the ground. Tony thought 
he saw Edward hit his head on the ground. 

Family friend said father was playing golf at the 
time of the alleged incident. 

Interview with family friend - Mr. Mitchell stated 
that he and Mr. Willingham were playing golf from 
3:30 to 6:00 at the Meadow Green Country Club. 

Tree in backyard could be site of injury. 

Social worker's observation - The observation of the 
backyard did not reveal a baseball bat, large stick 
or similar object; other toys were strewn about. 
Several large trees had low branches which could be 
used in climbing. Beneath the tree were stones 
which could have injured Edward if he fell. 

Polygraph indicated the father is probably telling 
the truth. 

Polygraph results; interview with police - 
Mr. Willingham requested a polygraph to prove his 
innocence. The police agreed to allow it, and it 
appears to confirm Mr. Willingham's previous account. 

The "ledger" sheet on the following page (Figure 3P) depicts the distri- 
bution of information in light of the report allegation and the need to 
show reasonable cause. 



8. Fact: 
Evidence. 

9. Fact: 
Evidence: 



10. Fact: 



Evidence: 



As a result of the analysis, the social worker concludes that there is 
no reasonable cause to believe that the skull fracture was the result of 
child abuse. 



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FIGURE 3P 
ALLEGATION: Skull Fracture 



REFUTING FACTS 




SUPPORTING FACTS 




FACTS 


RELIABILITY 


FACTS 


RELIABILITY 


J. Alleged perpetrator 


Poor 


1. Child has a frac- 


Excellent 


denies injuring the 




tured skull. 




child. 


• 










2. Physician states 


Excellent 


4. Mother stated that 


Good 


injury could be the 




the father did not 




result of abuse. 




injure the child. 












6. Neighbor reports see- 


Excellent 


5. Child denies that 


Good 


ing father hit the 




his father injured 




child with a large 




him. 




stick. 




7. Friend of victim 


Good 






states child fell 








from tree. 








8. Family friend said 


Good 






father was playing 








gplf at the time of 








the alleged incident. 








9. Tree in backyard 


Good 






could be site of 








injury. 


- 






10. Polygraph indicated 


Excellent 






the father is pro- 








bably telling the 








truth. 









EXAMPLE 2 - THE GABLES 



The Gables' s neighbor telephoned the hotline reporting that he observed 
Mrs. Gable's boyfriend punch her daughter, Sara Gable, in the stomach, 
and slap her face and buttocks. Sara is approximately five-years old. 
The neighbor overheard the boyfriend (Joe) warn Sara to put away her 
toys "next time". The allegations are cuts/welts and bruises, caused 
by physical abuse. 

The social worker assembled the following facts: 

1. Facts: 



Evidence: 



Alleged perpetrator was involved in a previously 
supported report of physical abuse. 

Investigative file, Investigation Summary Form 



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4. 



Fact: 

Evidence: 

Fact: 

Evidence: 

Fact: 
Evidence: 



5. Fact: 



Evidence: 

Fact: 

Evidence: 

Fact: 
Evidence: 



8. Fact: 



Evidence: 



9. Fact: 



Evidence: 



Boyfriend admitted disciplining child but not so 
severely to cause bruising. 

Interview with boyfriend, Joe Livingston, stated he 
slapped Sara once or twice with his open hand. 

Mother stated the boyfriend disciplined the child 
for not doing work around the house, and the child 
deserved the punishment. 

Interview with mother (Bobbie Sue Gable) was very 
supportive of Joe Livingston's action. She attri- 
butes the bruises to falling during outdoor play. 

Home was very clean. 

Worker's observation - The home was neat, well- fur- 
nished and clean. Dishes had been washed, there was 
no accumulated trash, the beds were made. 

Child's teacher stated that the child never has 
observable bruises. 

Interview with teacher - Sara never appears mis- 
treated and is a good student. 

Child indicated mother's boyfriend hit her for not 
putting her toys away. 

Interview with child victim - Sara indicated Joe 
Livingston did hit her, and that this occurs fre- 
quently. 

Bruises and welts observed on child's arms, thighs 
and buttocks. 

"Body Chart" School nurse's and social worker's 
worker's observations - Bruises were no larger than 
1" in diameter, but were readily observable. 

Child's sibling observed the incident and confirms 
victim's description. 

Interview with sibling - Tommy Gable saw Joe Living- 
ston hit Sara repeatedly and said he had seen it 
happen "a couple of times" before. 

Neighbor saw incident and described what occurred - 
confirming child's statement. 

Interview with neighbor. 



The social worker concluded that there is reasonable cause to believe 
that the cuts /welts /bruises were the result of physical abuse, based on 
the distribution of data as indicated on the "ledger" sheet depicted in 
Figure 3Q. 



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FIGURE 3Q 
ALLEGATIONS: Cuts /Bruises /Welts and Excessive Corporal Punishment 



REFUTING FACTS 






SUPPORTING FACTS 




FACTS RELIABILITY 


FACTS 


RELIABILITY 


2. Boyfriend admits dis- 


Poor 


1. 


Alleged perpetrator 


Excellent 


ciplining child, but 






was involved in a 




not so severely to 






previously supported 




cause bruising. 


■ 


■ 


report of physical 
abuse. 


. 


3. Mother stated the 


Poor 


2. 


Boyfriend admits dis- 


Good 


boyfriend disciplined 






ciplining the child. 




the child for not 










doing work around the 




3. 


Mother says child was 


Good 


house, and the child 






disciplined. 




deserved it. 














6. 


Child indicated 


Poor 


5. Child's teacher 


Good 




mother's boyfriend hit 




stated that the child 






her for not putting 




never has observable 






her toys away. 




bruises. 










i 




7. 


Bruises and welts 
observed on the child's 


Excellent 








arms, thighs and 
buttocks. 








8. 


Child's sibling 
observed the incident 
and confirms victim's 
description. 


Fair 






9. 


Neighbor saw the 
incident and des- 
cribed what occurred 
confirming child's 
statement. 


Good 



NOTE: Fact 4 does not pertain to the allegations and was, therefore, 
not considered. 

In each of the preceding examples, the social worker: 

followed the recommended steps 

collected pertinent evidence 

evaluated the reliability and importance of the evidence 

made a correct, justifiable decision 



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7. Summary 

The decision as to whether or not there is reasonable cause to believe 
that abuse and 7 or neglect exists is a critical one for the child's veil- 
being and the effect it has on the family. The social worker must not 
take this responsibility lightly; the future safety of the child is at 
stake. In addition, it is important that families are not erroneously 
labelled "abusive" or "neglectful." Accordingly, the evidence must tie 
fastidiously collected, evaluated and weighed. A correct decision 
requires careful attention to detail. 



FOOTNOTES 



1. William N. Frederick and Jerry A. Boriskin, "The Role of the Child in Abuse: 
A Review of the Literature", American Journal of Orthopsychiatry 46 
(October 1976): pp. 580-590. 

2. Ibid., p. 585. 

3. John Craft, Stephen Epley, and Cheryl Clarkson, "Factors Influencing Legal 
Disposition in Child Abuse Investigation", Journal of Social Service 
Research 4 (Fall 1980): p. 44. 

4. Blair Justice, Ph.D. and David F. Duncan, B.A., "Life Crisis as a Precursor 
to Child Abuse", Public Health Report 91 (March - April 1976): pp. 110-115. 

5. Ibid., p. 111. 



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CHAPTER III 
EVIDENCE 



III. EVIDENCE 



A. INTRODUCTION 

During the course of an investigation it must be remembered that the worker 
may eventually be called upon to testify in court, or that another Depart- 
ment emoloyee may take the witness stand concerning a case the worker 
investigated. Under either circumstance, the quality of the investigation 
will depend not only upon whether the worker followed the procedures out- 
lined in Chapter 2, but also on how well the investigation is documented. 
The finest investigation is rendered meaningless if the worker cannot recall 
detailed facts when appearing in court. 

The purpose of presenting evidence is to pursuade the Court that the Depart- 
ment's position or theory is correct; i.e., that there is a need for 
temporary custody or that abuse or neglect has occurred. Certain rules of 
evidence can limit the types of questioning permitted in court as well as 
the type of answers that will be allowed. While most child abuse and 
neglect cases do not result in court action, the worker must gather and 
collect evidence as though every case will be contested m court. 

8. TYPES OF EVIDENCE 

In rendering decisions, the court may rely only upon evidence successfully 
presented by the parties. Such evidence may be divided into four major 
categories: direct, demonstrative, circumstantial, and expert or opinion. 

2. Direct Evidence 

Of the four, direct evidence is the most persuasive. It is based upon 
personal knowledge or observations; it is equivalent to eyewitness 
accounts. In the courtroom, direct evidence can be provided only by 
the person who actually observed the facts. Thus, the worker would be 
able to provide direct evidence as to the condition of the home (e.g., 
"I saw animal feces on the living room floor"), and any other facts or 
conditions observed. However, the worker will not be able to observe 
all facts personally. For example, in an abuse investigation, a 
neighbor may have seen the parent hit the child. In such instances, 
the worker must record the neighbor's statement and identify the 
neighbor as a potential witness. 

2, Demonstrative Evidence 

This is an often neglected category. It includes objects directly 
related to the occurrence of suspected neglect or abuse (e.g., 2" x 4" 
board used to hit the child, x-rays, photographs ). Unlike direct evi- 
dence, demonstrative evidence first requires additional proof concern- 
ing the object's authenticity and relevance often referred to as a 
"foundation." For example, if a photograph of a bite mark on a child 
is to be used in court, the worker must first be able to relate: 



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when the photo was taken 

what the photo depicts 

that the photo is a fair and accurate view of the injury 

Additionally, especially when using demonstrative evidence, the worker 
may have to prove that the object has been under the consistent con- 
trol of themselves or someone else, to show that it has not been altered 
or tampered with. 

J. Circumstantial Evidence 

Less persuasive, but often required in order to prove a case of abuse or 
neglect, especially where there are no eyewitnesses, is circumstantial 
evidence. Circumstantial evidence is proof of circumstances which may 
imply another fact and from which the judge is required to make certain 
logical conclusions. For example, a neighbor's testimony that she often 
heard the child screaming when left alone with the father may be cir- 
cumstantial evidence or abuse. Another common example of circumstantial 
evidence is the absence of food in the child's home. The caretaker may 
state that the child eats well-balanced meals prepared by family mem- 
bers, but the absence of food in the house may be considered circum- 
stantial evidence supporting an allegation that the child is neglected. 
A final example of circumstantial evidence is the worker's observation 
that the caretaker had glazed eyes and slurred speech, was unable to 
stand ot walk, and smelled of alcohol. Based on this evidence, the con- 
clusion could be reached that the parent was intoxicated. Because cir- 
cumstantial evidence requires the judge to draw logical conclusions, the 
worker should collect as much circumstantial evidence as possible, 
especially where there is little or no direct evidence. 

4. Expert Evidence 

Finally, there is expert or opinion testimony which is evidence offered 
by a witness who has special expertise, skill or knowledge which is 
beyond that of the average person. An expert witness may testify after 
the court allows the witness to be qualified as an expert in the sub- 
ject of the opinion which is to be presented. Qualification of an 
expert depends on experience and education and is within the discretion 
of the court in each case. Experts may offer opinions on the matter at 
issue, for example, testimony by the pediatrician who diagnosed the 
child's injury, as to the cause of the injury. 

C. ADMISSIBILITY OF EVIDENCE 

Not every statement or document pertaining to a family member or situation 
may be admitted into evidence (i.e., accepted by the court). Rather, the 
rules of evidence can disallow testimony which has no bearing on the case 
or is unreliable, unduly prejudicial, or needlessly duplicative of past 
testimony upon proper objection. 

1. Relevant Evidence 

Relevant evidence includes any type of evidence which tends to prove or 
disprove a fact of consequence that is part of the controversy. An 



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example would be whether the caretakers belong to a church. This would 
generally be irrelevant, but if the church forbids the provision of 
medical treatment, and failure to provide medical treatment was an 
allegation, then church membership would be relevant. 

2. Prejudicial Evidence 

As a general rule, relevant evidence may be admitted over objection 
unless the court decides it is too prejudicial or violates an accepted 
rule of evidence such as hearsay. Prejudicial evidence is that which 
unduly arouses or has the potential to arouse the judge's emotions of 
hostility or sympathy without substantially contributing to its prohibi- 
tive value. For example, color photographs of exceedingly gruesome 
injuries may be thought to cloud the court's ability to remain an impar- 
tial fact finder. Nonetheless, photographs of the injured child should 
be taken (see Chapter 2); the worker should not predict whether or not 
they will be admissible; another example would be a nude photo of the 
child when the injury could be seen when the child was clothed. 

J. Objections 

Opposing counsel can and often do object to evidence they deem inadmis- 
sible (e.g., not relevant, unduly prejudicial, or hearsay). When an 
objection is voiced, the worker should immediately stop testifying. At 
this time, counsel may argue before the judge on the validity of the 
objections. The judge will then rule on the objection by sustaining 
(upholding) or overruling (rejecting) it. If the objection is over- 
ruled, the worker will be permitted to answer the question. Often, if 
the judge upholds the objection, the information may still be brought 
to the court's attention by changing the wording in the question or 
response. There may be times when in answering the DSS attorney's 
questions, the worker is uncertain about how much information to give. 
As a general rule, the worker should give as much information as seems 
necessary; the attorney can always limit the worker's response by either 
cutting him off or asking that part of his response be stricken from 
the record as not responsive to the question. It is important not to 
be upset by this maneuver. 



0. HEARSAY 



Hearsay is any oral or written statement (1) not made in court, (2) made 
when the declarant could not be cross-examined, and (3) offered in court as 
evidence of the truth of its content. If you repeat to the court what some- 
one else told you, it may be hearsay. For example, if the worker testifies 
that "the neighbor told me she saw the child leave the house with facial 
bruises," that testimony constitutes hearsay and can be excluded from 
admission into evidence. In such cases, the neighbor, not the worker, 
should offer the testimony. 

1. Rationale For The Hearsay Rule 

Hearsay testimony, barring certain exceptions discussed below, is inad- 
missible in court. The reason for this rule is that this evidence is 
unreliable in that it could prevent the parents from confronting their 
accusers. The previous example illustrates the point: the neighbor 



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should be subject to cross-examination so that the judge can evaluate 
the evidence in terms of accuracy, (e.g., how far away the child was), 
perception, memory, articulateness, sincerity, demeanor, bias, and 
credibility. Subjecting the neighbor to cross-examination might reveal, 
for example, that the neighbor and parent had numerous previous fights 
over a property line, raising the possibility that the neighbor's state- 
ment was biased. 

2. Exceptions To The Hearsay Rule 

Certain hearsay statements may be admitted into evidence under one of 
several recognized exceptions to the hearsay rule. These exceptions 
are based upon circumstances which tend to make the statement more 
trustworthy, hence diminishing the concern about reliability. Several 
of these exceptions are frequently useful in child abuse/neglect cases. 

a. Admissions by a Party 

Statements of actions made by a party (i.e., parent, minor who is a 
subject of oroceeding, guardian, or legal custodian) may be offered 
in court, Drovided that the statement goes against his self-interest. 
In these situations, it is presumed that a person would not say 
something against himself unless it was true and that he will be 
able to explain the statement when he testifies. For example, "the 
parent told me she often left her two-year-old unattended while she 
went shopping." It is important to note that the worker may testify 
to an admission only if the worker personally heard the individual 
make the statement. However, statements which support the person 
(rather than being against his interests) are not admissible; these 
are self-serving and remain unreliable. An admission may also be 
made by silence. A person may be said to tactily accept a statement 
made by another in his presence, provided that you can show the 
party heard and understood the statement and had an opportunity to 
object to it. For example, the statement a neighbor makes to you 
about having seen the parent leave the infant unattended, if made in 
front of the parent and the parent fails to object, may be an 
admission by silence. Admission by silence is not usually encouraged 
when the court has before it people who have a marginal capacity for 
dealing with society. 

b. Excited Utterances 

Certain spontaneous statements made at the time of or immediately 
following a startling or exciting event or condition are admissible 
hearsay. These declarations are deemed more reliable because they 
are made in reaction to stress, presumably without premeditation or 
time to reflect and fabricate. Statements made some time after the 
event do not qualify. For example, "I heard the babysitter scream 
out the window, 'Help, Mr. Smith is hitting the baby, '" would be 
admissible testimony under this exception. However, "The baby- 
sitter told me that last week she saw Mr. Smith hit his baby" would 
be inadmissible. Often the excited statement is heard by Mr. Smith 
who then tells the witness; this is called "totem pole hearsay" and 
thus falls out of the exception. 



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c. Statements Showing State of Mind 

A person's direct statement regarding his state of mind is also 
admissible hearsay. For example, a parent might say to the worker, 
"I've had it with those kids, they're really getting to me." The 
fact that the speaker thought it is admissible over objection. 
Whether she could or could not take any more, though, could be the 
inference. 

d. Statements of Present Physical Sensations 

A statement is admissible hearsay if it concerns a physical condi- 
tion or sensation at a certain time and is used to prove the exis- 
tence of the condition or sensation. As with excited utterances, 
the key is timeliness or spontaneity. The statement must be made 
at the time the condition or sensation is felt. For example, "Just 
after the girl tripped, she told me, 'My head hurts. '" 

e. Business Records 

Records, photographs and x-rays of any business such as hospital or 
public or private agency, are admissible hearsay if: 

they were made in the regular course of business of the 
hospital or agency 

° it was in the regular course of business to make such records 

the entries or document were made at or near the time of the 
transaction or event, and 

the records were not made in preparation for litigation (court 
case) 

Before such records or documents may be introduced, someone must 
certify that they were in fact made in the regular course of 
business at or near the time of the event, (foundation ) 

Under the business records exception, the case file may at times be 
admissible. Although the records are often replete with double 
hearsay, these statements may be admissible if they independently 
fit an accepted hearsay exception. For example, if an entry con- 
cerning the worker's interview with a parent contains direct state- 
ments made by the parent, it may still be admitted into evidence if 
(a) it qualifies as a business record, and (b) the parent's state- 
ment was an admission. Even if the record itself contains inadmis- 
sible hearsay, portions of the record which are free of these state- 
ments may be admitted into evidence by deleting the inadmissible 
statements. 



E. USE OF DOCUMENTS AND TANGIBLE EVIDENCE 

The worker must often rely upon certain documents (see Chapter 5) and other 
tangible evidence, either in preparing for his testimony or for actual use 
in the courtroom. With respect to the latter, these documents may be used 
in one of two ways: 



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to introduce the actual document into evidence (i.e., the court may 
consider the document in rendering a decision), or 

to refresh your memory while on the witness stand (i.e., you refer to 
the document merely to help you recall information during your oral 
testimony). It is important that you should refresh your memory only 
if it is exhausted and not simply read your notes; not only is it 
objectionable but it becomes boring and less than compelling. 

From an evidence perspective, documents which contain hearsay, unless they 
qualify under an exception, may not be introduced as evidence; however, 
they may be used as an aid to refresh your memory so that you can testify 
more accurately (and in such a situation they are not introduced as evi- 
dence). It is important to note, however, that opposing counsel is entitled 
to examine the materials used to refresh your memory and may utilize them 
on cross-examination. Furthermore, whenever a written document, photo- 
graph, or some other form of tangible evidence is introduced in court, a 
witness must be able to identify it and show its reliability and relevance. 

1. Photographs 

Photographs can obviously be a very persuasive form of evidence. You 
must introduce them at a hearing, even if you did not take the 
picture, provided that you can testify that the picture is a true, 
accurate, and faithful representation of the injury or scene at the 
time the picture was taken. On each photograph the date, place and 
time the picture was taken, the subject of the photograph, and the names 
of the photographer and other workers present should be recorded 

2. X-Rays 

X-rays are another graphic form of evidence. They may be used to show 
a current injury and may also be invaluable in showing a pattern of 
previous injury. While' x-rays are admissible to demonstrate the extent 
and severity of injuries, they always require expert medical testimony 
from a doctor or radiologist. 

3. Medical Records 

Medical records include those maintained by hospitals, treating physi- 
cians, school doctors, and public health nurses. Remember, if the 
records will be introduced into evidence, they must be authenticated 
and qualify under the business records exception. Even if some of the 
record contains inadmissible hearsay, it is permissible to introduce 
only those parts which qualify. (See pg. 83 "Exceptions To The 
Hearsay Rule"). 

4. Miscellaneous Records 

Other records which may aid the worker's investigation and assist in 
trial preparation and courtroom testimony include mental health evalua- 
tions, school records, and prior child abuse/neglect reports. 



-85- 



5. Obtaining Documents And Other Evidence 

Documents and tangible objects are often critical evidence in child 
abuse and neglect hearings and should be examined by the worker. Some 
of these, such as photographs, x-rays, and court-ordered mental health 
■evaluations prepared or taken as a direct result of a child abuse/ 
neglect investigation, may be barred from the worker's review. Many of 
these records are confidential pursuant to other laws, or due to a con- 
fidential, professional-client relationship, (e.g., doctor-patient ). 
There are however, certain techniques by which the worker may overcome 
these apparent bars or lessen their effects. 

a. Consent 

In most cases, the subject of a report or record may waive the con- 
fidentiality restrictions. For example, a parent can sign a 
release statement authorizing the release of mental health evalua- 
tions of himself or his minor children. These releases should be 
specific; they should be dated, time limited, and refer to specific 
types of records. The Department has a standard medical release of 
information form. 

b. The Case Record 

The case record is the worker's most important reference. The 
value of investigation is seriously undermined if the information is 
inadequately recorded. Child abuse and neglect typically involves 
a pattern of behavior, necessitating ongoing case monitoring and 
record-keeping. The record-keeping must begin at receipt of the 
report in all cases of suspected child abuse or neglect. Regard- 
less of how receptive to services and workable a parent or guardian 
may appear, every protective service case has a potential for court 
action. In compiling the case record, the worker must remember that 
notes will subsequently be utilized by supervisors and follow-up 
workers. Thus, the record must be maintained according to agency 
policy in order to maximize its current and future use. In com- 
piling the record, the worker must presume not only that the case 
will result in court action, but also that he will have for 
gotten many of the facts by the time of the hearing. 



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CHAPTER IV 
RECORDING INFORMATION 



IV. RECORDING INFORMATION 



A, INTRODUCTION 

The appropriate recording of information is a necessary and fundamental 
skill required to conduct professional investigations, a skill which is too 
often overlooked. Quality investigations require thorough documentation in 
order to: 

establish a chain of evidence, 

provide necessary information to plan an investigation, 

note inconsistencies in interviewees' statements, and 

assist the worker in recalling information for court or administrative 
review testimony. 

Decision making by social workers is a calculated process. Proper investi- 
gative documentation will assist the worker in making decisions by: 

enhancing the communication between worker and supervisor, 

serving , as a justification of the worker's decision, and 

gathering all the information in one place to facilitate the decision- 
making. 

The case record serves purposes in addition to aiding the social worker in 
planning for and conducting the investigation. Future social workers who 
may deal with the family will benefit from the information contained in the 
record. Thorough documentation will also demonstrate that all standards 
and mandates have been met. 

The first section of this chapter discusses documentation skills, i.e., how 
to record investigative data in an effective and concise manner. 

B. DOCUMENTATION SKILLS 

In preparing narrative summaries for the case record, workers must keep in 
mind the purpose of these summaries: 

to list the facts and direct observations obtained during the course of 
the investigation, and 

to list the evidence that supports the facts. 

To accomplish these two objectives, the narrative must be: 

thorough 

° accurate 

clear 



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timely 
factual 

1. Thoroughness 

' By being thorough, the social worker attemots to secure all information 
necessary to make critical decisions affecting the safety of children. 
An effective way to assure thoroughness is to ask the five categories 
of questions: Who, What, When, Where and How, as discussed in the 
following. 

2. Accuracy 

Mistakes in the accuracy and recording of information can be very costly 
to the child, family and /or worker. Lack of accuracy can lead to poor 
decision-making, convey misinformation to follow-up workers, and fail to 
support the worker's judgment in court. Therefore, a worker must always 
keep two things in mind in recording information: 

review the accuracy of the information, and 

make calculated decisions based on the facts. 

J. Clarity 

The case record may be read by a number of individuals, particularly if 
the report is supported. The spectrum of potential readers is wide, 
including supervisprs, spcial workers, attorneys, and judges. There- 
fore, it is important that the information is organized and precise, and 
that the summary statements are brief. 

a. Organization 

Effective documentation must closely follow the facts and evidence 
collected by the social worker but not necessarily in the order in 
which those facts and evidence were collected. "Planning must be a 
deliberate prelude to writing. The first principle.. .is to fore- 
see or determine the shape of what is to come and pursue that shape"* 
When social workers decide whether a report is supported or un- 
supported they do so by verifying the collected facts and 
evidence (see Chapter II, Decision Making). In the Investigation 
Summary, these facts should be presented in an order that upholds 
the decision. A simple statement that reseasonable cause did or did 
not exist is insufficient to allow the reader to reach a deter- 
mination. For example, assume a situation where a two-year-old is 
brought to the hospital with a fractured arm. The parent's explana- 
tion is that the child fell while standing on her chair watching 
television. An appropriate investigative summary leading to a deci- 
sion to support the report might read as follows: 

The seat of the television chair measures eight inches from the 
floor, which is thickly carpeted. 

Dr. Johnson reports little likelihood that the fracture could 
have resulted from an eight-inch fall onto such a surface. 



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The social worker reports that the father has physically abused 
other children in the family. 

From this brief, organized presentation, the reader can understand 
the social worker's reasoning in making the decision. 

b. Precision 

"Prefer the specific to the general, the definite to the vague, the 
concrete to the abstract."? As illustrated, the following two 
statements are imprecise: 

The child displayed a positive reaction to her mother's lavish 
attention. 

The alleged perpetrator returned home from work in a bad mood. 

Neither of these two statements provide the reader with a clear 
picture of what the investigator observed. The statements convey 
considerably more information when written as follows: 

The child smiled and laughed when her mother hugged her. 

The alleged perpetrator returned home from work at 6:00 p.m., 
slamming the front door and shouting obscenities at his wife. 

c. Brevity 

Effective writing is concise. The case record should contain no 
unnecessary words or sentences. Lengthy, run-on sentences only con- 
fuse the reader. If short, declarative sentences are used, com- 
pleteness or accuracy need not be sacrificed. Nouns and verbs are 
the key to effective writing, not adjectives and adverbs. "The 
adjective hasn't been built that can pull a weak or inaccurate noun 
out of a tight place. "3 The following statement provides an example: 

The fact that he did not regularly prepare dinner for the child- 
ren was due to his employer's insistence that he work overtime. 

This sentence can be rewritten as follows: 

He did not prepare dinner regularly because he had to work 
overtime. 

In this example, needless words are avoided, and the same informa- 
tion is conveyed more effectively. 

A, Timeliness 

Timeliness in recording information is important for two major reasons: 

The sooner the information can be recorded, the more accurate it is 
likely to be. 



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In order for the information to be admitted in a court hearing, 
records must: 

be made in the regular course of an investigation, 

be made at or near the time of the transaction or incident, and 

be able to be authenticated (See Chapter III, Evidence). 

Thus, not only is it important to record the information in a timely 
fashion, it is also essential that the date and time of the recording 
be noted. 

5. Separating Facts From Judgments 

In recording information, it is important for the worker to separate 
facts from the judgments the worker made about those facts. This 
separation encourages the worker to detail the facts of the investiga- 
tion before forming judgments. The facts should support the judgment, 
not vice versa. The statement "Mrs. Brady displayed inadequate home- 
making techniques" is a judgment and a conclusion. "Mrs. Brady's 
children's clothes were dirty" are the facts to help support that 
conclusion. 

In forming and recording professional judgments about a family's needs 
and problems, workers should be extremely cautious with labelling terms, 
e.g., "Mr. Jones is immature." Not only is the use of labelling poten- 
tially libelous, it can alsct unfairly bias readers of the record. Care 
should also be taken to avoid the use of psychological or medical 
diagnoses describing client conditions /behavior which the worker is not 
qualified to make. 

6. Who, What, When, Where, How Questions 

a. Who Questions 

"Who" questions elicit information regarding the composition of the 
family, the identity of other significant persons interacting with 
the family, and the identity of persons alleged to have participated 
in an incident under investigation. 

Some "who" questions a worker may ask include: 

Who are the members of the family? 

Who are significant others (relatives, friends) involved with 
the family? 

Who is the source of medical care for the child? 

° Who was involved in the situation? 

Who was present during the incident? 



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b. What Questions 

"What" questions elicit information regarding actions, events, 
physical objects, and the condition of persons or things. Some of 
the important "what" questions a worker may ask are: 

What happened? 

What is the relationship between subjects? 

What is the family's history in terms of abuse or neglect of 
the child? 

What is the condition of the home? 

What is the present physical condition of the child? 

c. When Questions 

"When" questions elicit information on the sequence of events which 
is often critical to investigative activity. That is, knowledge of 
the whereabouts of subjects at certain times can attest to the vera- 
city of the subjects' statements. Although workers may not always 
be able to determine the exact time of an event, e.g., 8:15 a.m., 
they may be able to determine a time period in which an event may 
have occurred, e.g., between 8:00 a.m. and 10:30 a.m. 

Some "when" questions a social worker may ask include: 

When did the incident occur? 

° When does the child leave for school? 

° When does the caretaker return home from work? 

When was the child's last medical examination? 

When do the children eat their meals? 

d. Where Questions 

"Where" questions provide a worker with a variety of information 
necessary to locate a family, identify where an incident may have 
occurred, identify schools the children may be attending, and where 
on the body a child was injured. Examples of questions asked to 
elicit this information are: 

Where was the caretaker when the child was injured? 

Where do the children attend school? 

Where did the injury occur? 



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Where is the child now? 

Where does the alleged perpetrator live? 

In recording answers to "where" questions, it may be necessary to 
describe a specific location. When doing so, always be factual and 
thorough. 

e. How Questions 

"How" questions elicit information which may be used by the worker 
in determining what occurred to produce a specific injury or event. 
Examples of "how" questions include: 

How was the child injured? 

How do the children get home from school? 

° How does the caretaker discipline the child? 

° How did the reporter come to know the situation? 

How did the police become involved in the incident? 



FOOTNOTES 

1. William Strunk, Jr., and E.B. White. The Elements of Style . Third Edition 
(New York: MacMillan Publishing Co., 1979): p. 15 

2. Ibid., p. 21. 

3. Ibid., p. 71. 



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CHAPTER V 
CONCLUSION/ 'SUMMARY 



V. CONCLUSION /SUMMARY 



A. INTRODUCTION 

Thorough review of the Reference Guide inevitably leads the reader to con- 
clude that well-developed professional skills and awareness of resources are 
required to conduct a thorough and timely investigation of suspected child 
abuse or neglect. The Guide explains the investigative process, delineates 
techniques to improve social workers' effectiveness and efficiency, provides 
explicit guidelines for making key decisions, explains the effect of evi- 
dentiary requirements on 'the investigation and judicial proceedings, and 
demonstrates appropriate documentation methods. 

The purpose of this section is not to replicate the basic principles detailed 
above, but rather, to highlight how the chapters interrelate to facilitate 
investigation and decision-making. The components of the investigative 
process and the chapters may be viewed as building blocks which must be 
assembled in order to provide a framework through which the child's safety 
and health can be assured. Unassembled blocks are meaningless until they 
can be integrated in a logical configuration, one building upon and serving 
as the base for another, until the goal of protecting the child is reached. 

Investigations require the close cooperation of a variety of professionals, 
each striving to achieve the goal of protecting children from abuse and 
neglect. Sometimes professionals disagree on which approach, technique, or 
activity will best assure the child's health and safety and minimize inter- 
vention into family life. Disagreements may be healthy and provide oppor- 
tunities to explore new approaches or philosophies. Nonetheless, social 
workers and community professionals must work together and cannot let 
philosophical or practical differences override the importance of protect- 
ing children. 

B. THE RECEIPT OF A REPORT 

Report receipt is the base on which the investigative plan is built. It 
sets the tone for the investigation. It may determine the advisability of 
securing emergency services. Later, the investigative plan may be altered 
based on evidence collected from the social worker's initial contacts. 
Accordingly, it is critical that the reporter and receiving worker obtain 
as much pertinent, correct, and timely information as possible on the 
current condition of the child. 



C. DEFINING THE PARAMETERS OF INVESTIGATION 

One of the earliest decisions confronted by the social worker is determin- 
ing the seriousness of the report. Effective planning can minimize inter- 
vention into family life and make most efficient use of DSS staff so that 
more investigations can be completed and the safety of more children assured. 
The social worker's initial decisions regarding the report guides the type of 
interviews conducted, the evidence gathered, the observations made, and the 
individuals consulted - such as the supervisor, legal staff or additional 
social workers. 



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0. INVESTIGATIVE TECHNIQUES: OBSERVE, INTERVIEW, GATHER EVIDENCE 

The investigative plan is put into effect through the application of three 
basic investigative techniques: observing, interviewing, and gathering 
evidence, A word of. caution is appropriate - the term "basic" should not be 
interpreted to denote "simple." On the contrary, each technique requires 
experience, training, and skill. Interviewing a five-year-old child who 
allegedly was sexually abused, for example, is a difficult and demanding 
task which requires the social worker to draw upon previous experience, know- 
ledge of child development (see Appendix E), and play interview techniques. 

The social worker's observations focus on six primary areas (see Appendixes 
C and D): 

physical /medical indicators of abuse /neglect, 

behavioral indicators of abuse /neglect, 

caretaker's attitudes, 

family functioning, 

physical condition of the home, and 

physical condition of the surrounding neighborhood. 

These observations must be analyzed in light of the developmental milestones 
of the child and potential cultural biases. 

Interviews are a critical component of the investigation. Explanations pro- 
vided by report subjects are important in ascertaining what, if anything, 
happened to the child. Comparison of information provided by various 
sources inside and outside the family, particularly in light of observations 
made by the social worker or collateral sources, serves as a cross-check on 
the validity of the report allegations. 

To support observations made by the social worker or collateral sources, docu- 
ments, reports, and related demonstrative evidence may be gathered. These 
may include: 

medical records (including x-rays) 

mental health evaluations 

school attendance records 

prior reports of abuse/neglect 

These documents may be essential to a complete investigation and may help 
the social worker and/or DSS legal staff prove the Department's position in 
judicial proceedings. 

E. DOCUMENTATION 

One product of the investigation is a compilation of documents which reflect 
the observations made, interviews conducted, and evidence gathered by the 

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worker. Thorough documentation of all aspects of the investigation is 
required and helps the worker(s): 

weigh evidence 

make decisions 

justify decisions to supervisors, administrators, and others 

present evidence in court 

determine the family's need for follow-up services 

Adequate investigative documentation is predicated on good writing skills 
whereby the social worker separates facts from opinions, organizes the 
information, writes in clear, precise terms, and records information. 

F. WEIGHING EVIDENCE 

Once the social worker has compiled and documented the evidence and double- 
checked its accuracy, an evaluation must be made of the reliability and 
importance of the information. Drawing upon the activities outlined in the 
previous steps, the social worker reviews conflicting data and weighs it in 
light of: 

reliability of the information source 

corroboration by third-party, non-involved sources 

olausibility of explanations in view of observations 

importance to decisions at hand 

effect on assessment of risk to child 

Weighing evidence is perhaps the most difficult aspect of the decision- 
making process, as it requires thoughtful consideration of significant 
amounts of information and comparative evaluations of data in which no 
single "correct" answer or outcome can be readily identified. 

G. DECISION MAKING 

Correct decisions are the result of thorough, timely investigations includ- 
ing corroboration, double-checking, and assessment of the reliability and 
importance (weighing) of evidence. Although a multitude of decisions con- 
front the investigator each day, the outcomes of those decisions help plan 
and conduct activities to ascertain the level of risk to the child and to 
determine the validity of the report allegations. 

1. Risk Assessment 

Assessing risk is a skill which cannot be wholly learned or prescribed. 



-95- 



Although guidelines are provided in the Guide, professional judgment 
plays a significant role in the decision. Of particular importance are 
the child's age, the level of cooperation exhibited by the caretaker, 
the access of the alleged perpetrator to the child, the severity of the 
incident /injury, and the physical condition of the home. The social 
worker must apply observation, interviewing, and evidence-gathering 
■ techniques to make this determination. 

2. Investigation Decision 

Allied to, and frequently dependent upon, the assessment of risk is the 
social worker's decision as to whether there is reasonable cause to 
believe that abuse and /or neglect exists. This does not imply, however, 
that an assessment of lower risk to the child indicates that no 
evidence of abuse and/or neglect exists. (The infamous "one-time-only" 
incident of excessive physical punishment is an apt example.) This 
decision is a key decision, as it shapes the Department 's future inter- 
action with the family. A reoort in which the allegations are sup- 
ported is referred to staff who determine what, if any, services are 
necessary. A report in which the allegations are unsupported may be 
referred for voluntary services if the family so desires. 

H. PROTECTING THE CHILD 

The goal of the efforts detailed above and throughout this Guide is the pro- 
tection of the child. This goal is of paramount importance, possibly to the 
temporary detriment of other Department goals, such as reuniting the family, 
strengthening family functioning, and assuring permanency for each child. 
These goals reemerge when a supported report results in provision of ser- 
vices, and service plans and client-specific goals are developed. 

The child cannot be considered protected until the social worker has con- 
ducted a thorough, timely investigation, documented his findings, cross- 
checked all evidence gathered, weighed the evidence in light of decision- 
specific factors, assessed the risk of harm to the child, made a decision 
regarding the validity of the report allegations, and, when the report is 
suoported, assessed the need for services. 



A FEW FINAL WORDS 

The Commonwealth of Massachusetts is committed to protecting children; that 
is the theme of this Guide. The information in its chapters is a compila- 
tion of traditional and current expertise arrived at by research and practice, 
all aimed at encouraging child Drotection staff to develop their skills to 
the utmost. 

Production of this Guide, even considering the vital importance of its sub- 
ject, has been a laborious and complicated project. In a sense, it will 
never be completed. Department staff will continue to refine and update it 
as improved methods are developed. 

The authors of this handbook offer to child protection staff their best wishes 
and support. Yours is a difficult and challenging task, as well as a noble 
one. Good luck. 

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APPENDIX A 
GLOSSARY OF TERMS 



Massachusetts Department of Social Services Regulations 



GLOSSARY 



Abuse (As defined by Department Regulation 2.01) 

The non-accidental commission of any act by a caretaker upon a child under age 
eighteen (18) which causes, or creates a substantial risk of , serious physical 
or serious emotional injury, or constitutes a sexual offense under the laws of 
the Commonwealth. This definition is not dependent upon location (i.e., abuse 
can occur while the child is in an out-of-home setting). 

Caretaker (As defined by Department Regulation 2.07) 

A child's parent, stepparent, guardian, any household member entrusted with the 
responsibility for a child's health or welfare, and any otner person encrusted 
with tne responsibility for a child's health or welfare, whetner in the child's 
home, a relative's home, a scnool setting, a day care setting (including 
babysitting), a foster home, a group care facility, or any other comparable 
setting. As such, "caretaker" includes (but is not limited to) school teachers, 
babysitters, school bus drivers, camp counselors, etc. The "caretaker" derini- 
tion is meant to be construed broadly and inclusively to encompass any person 
who is, at the time in question, entrusted with a degree of responsibility for 
the child. This specifically includes a caretaker who is him/herself a child 
(i.e., a babysitter under age 18). 

Child 

A person who has not reached his/her eighteenth (18) birthday, but does not 
include unborn children. 



Collateral Contacts 

Contacts made by the Department, whetner by telepnone or face-to-face meeting, 
which attempt to gain further information, or clarify information the Depart- 
ment has already received about a particular family or child in question. A 
collateral can be a professional (therapist, teacher, doctor, etc.) or non- 
professional (friend, neighbor, relative, etc.) identified as having informa- 
tion abouc a family or particular family member. 

Emergency (As defined by Department Regulation 2.20) 

A situation where tne failure to take immediate action would place a family and/ 
or child at substantial risk of serious imminent family disruption, or death, or 
serious emotional or physical injury. 

Neglect (As defined by Department Regulation 2.35) 

Failure by a caretaker , either deliberately or through negligence or inability, 
to take those actions necessary to provide a child with minimally adequate food, 
clothing, shelter, medical care, supervision, emotional stability and growth, 
or otner essential care. This definition is not dependent upon location (i.e., 
neglect can occur while the child is in an out-of-home setting). 



GLOSSARY (continued) 



Serious Emotional Injury 



An impairment to or disorder of the intellectual or psychological capacity of a 
child as evidenced by observable and substantial reduction in the child's 
ability to function within a normal range of performance and behavior. 



Serious Physical Injury 

° death; or 

° fracture of a bone, a subdural hematoma, burns, impairment of any organ, 
and any other such nontrivial injury; or 

° soft tissue swelling or skin bruising depending upon such factors as the 
child's age, circumstances under which the injury occured, and the number 
and location of bruises; or 

° addiction to drug at birth; or 

° failure to thrive. 



APPENDIX B 
ABUSE AND NEGLECT DEFINITIONS 



1. Taber's Cyclopedic Medical Dictionary . Edited by Clayton L. Thomas M.D. 
M.P.H., Philadelphia: F.A. Davis Company, 1981. 

2. Interdisciplinary Glossary on Child Abuse and Neglect: Legal, Medical, 
Social Work Terms, Washington, D.C.: U.S. Government Printing Office, 1978. 



1 . DEATH 



Definition: Permanent cessation of all vital functions. The following 

definitions of death have also been considered: a. Total 
irreversible cessation of cerebral function, spontaneous 
function of the respiratory system, and spontaneous 
function of the circulatory system. b. The final and 
irreversible cessation of perceptible heart beat and 
respiration. (1) 



2. BRAIN DAMAGE /SKULL FRACTURE 



Definition: Brain Damage 



Injury to the large soft mass of nerve tissue contained 
within the cranium/ skull . 

Skull Fracture: 

A broken bone in the skull. (1) 



3. SUBDURAL HEMATOMA 



Definition: Hematoma: 



A swelling or mass of blood (usually clotted) confined to an 
organ, tissue, or space caused by a break in a blood vessel. 

Subdural : 

Beneath the dura mater (the outer membrane covering the 
spinal cord and brain). 

A subdural hematoma is located beneath the membrane covering 
the brain and is usually the result of head injuries or from 
shaking an infant or small child. It may result in loss of 
consciousness, seizures, mental or physical damage. (1) 



4. INTERNAL INJURIES 

Definition: An injury not visible from the outside, as injury to the 

organs occupying the thoracic, abdominal, or cranial cava- 
ties and can be the result of a direct blow. A person so 
injured may be pale, cold, perspiring freely, has an anxious 
expression or may seem semicomatose. Pain is usually 
intense at first, and may continue or gradually diminish as 
patient grows worse. (1) 

5. BURNS /SCALDING 

Definition: Burns: 

Tissue injury resulting from excessive exposure to thermal, 
chemical, electrical or radioactive agents. The effects 
vary according to the type, duration and intensity of the 
agent and the part of the body involved. Burns are usually 
classified as follows. 



First Degree: 

Superficial burns, damage being limited to the outer layer 
of skin. Scorching or painful redness of the skin. 

Second Degree: 

The damage extends through the outer layer of skin into the 
inner layers of skin. Blistering will be present within 24 
hours . 

Third Degree: 

Burns in which the skin is destroyed with damage extending 
into underlying tissues, which may be charred or coagulated 

Scalding: 

A burn to the skin or flesh caused by moist heat and hot 
vapors, such as steam. A scald is deeper than a burn from 
dry heat and should be treated as a burn. (1) 



POISONING/NOXIOUS SUBSTANCES 



Definition: 



Poison 



Any substance taken into the body by ingestion, inhalation, 
injection, or absorption that interferes with normal 
physiological function. Virtually any substance can be 
poisonous if consumed in sufficient quantity; therefore, 
the term poison more often implies an excessive degree of 
dosage rather than a specific group of substances. Asprin 
is not usually thought of as a poison, but over doses can 
kill more children accidentally each year than any tradi- 
tional poisons. 

Noxious : 

Harmful, injurious, not wholesome. (1) 



WOUNDS 



Definition 



An injury to the child's body caused by a knife, gunshot or 
other potentially lethal weapon in which the skin or other 
tissue is broken, pierced, cut or torn. 



8. MALNUTRITION 



Definition 



Lack of necessary or proper food substances in the body 
which may be caused by inadequate food (lack of food or 
insufficient amounts of vitamins). (1) 



9. BONE FRACTURES 

Definition: A fracture is a broken bone. There are ten types of 

fractures, the most common being: 

Simple: 

The bone is broken, but there is no external wound. 

Compound : 

The bone is broken, and there is an external wound leading 
down to the site of fracture or fragments of bone protrude 
through the skin. 

Complicated : 

The bone is broken and has injured some internal organ, 
such as a broken rib piercing a lung. 

Communicated : 

The bone is broken or splintered into pieces. 

Spiral : 

Twisting causes the line of the fracture to encircle the 
bone in the form of a spiral. (1 & 2) 

10. EXCESSIVE CORPORAL PUNISHMENT 

Definition: Excessive corporal punishment is disciplinary action taken 

by a parent or caretaker in which the following conditions 
or factors are present: 

1. The disclipine is the result of an inappropriate action 
or inaction of the child. 

2. The intensity of the parent's reaction does not cor- 
respond with the seriousness (or lack) of the child's 
act ion /inaction. 

3. It is apparent that the parent did not control his 
reaction by stopping the punishment before it caused 
injury. 

In addition to the preceeding, one of the following must 
also be present: 

1. Bodily injury 

2. An injury which is located in an area on the body which 
is normally associated with corporal punishment (i.e., 
bruises near the corner of the eye rather than on the 
buttocks ) . 



11. CUTS /BRUISES /WELTS 



Definition: Cut 



An opening incision, or break in the skin made by some 
external agent* 

Bruise : 

An injury resulting in bleeding within the skin, where the 
skin is discolored but not broken. Bruises are usually 
classified by size: 

Petechiae: Very small bruises caused by broken capil- 
laries. It may be the result of trauma or 
may be caused by clotting disorders. 

Purpura: Petechiae which occur in groups or a small 

bruise (up to 1 cm in diameter). 

Ecchymosis: A larger bruise 

Welt: 

An elevation on the skin produced by a lash, blow, or 
allergic stimulus. The skin is not broken and the mark is 
reversible. (1 & 2) 



12. HUMAN BITES 

Definition: A wound, bruise, cut or indentation in the skin caused by 

seizing, piercing or cutting the skin with human teeth. 

13. SPRAINS /DISLOCATIONS 

Definition: Sprain: 

Trauma to a joint which causes pain and disability depend- 
ing upon the degree of injury to ligaments. In a severe 
sprain, ligaments may be completely torn. The signs are 
rapid swelling, heat and disability, often discoloration and 
limitation of function. 

Dislocation: 

The displacement of any part, especially the temporary dis- 
placement of a bone from its normal position in a joint. 
Types include: 

Closed: A simple dislocation 

Complete: A dislocation which completely separates 

the surface of the joint 

Complicated: A dislocation associated with other major 

injuries 

Compound: Dislocation in which the joint is exposed 

to the external air (1 & 2) 



14. TYING/CLOSE CONFINEMENT 



Definition 



Unreasonable restriction of a child's mobility, actions or 
physical functioning by tying the child to a fixed (or 
heavy) object, tying limbs together or forcing the child to 
remain in a closely confined area which restricts physical 
movement. Examples include, but are not limited to: 

1. Locking or otherwise requiring a child to remain in a 
room for an unreasonable period of time. 

2. Locking the child in a closet, for any period of time. 

3. Tying one or more limbs to a bed, chair or other object. 

4. Tying the child's hands behind his back. 



15. DRUG/ALCOHOL ABUSE 



Definition 



Drug Abuse: 

The use or overuse of any substance that when taken into 
the body may modify one or more of its functions. Use of a 
drug in a manner that deviates from the prescribed pattern. 

Alcohol Abuse: 

Alcohol is a specific type of drug which is present in fer- 
mented or distilled liquors. Alcohol abuse implies exces- 
sive inappropriate use of alcohol which materially affects 
motor coordination and judgement. 

Fetal Alcohol Syndrome or withdrawal from drugs at birth 
which is caused by a mother's alcohol or drug addiction/ 
abuse is considered child abuse. 



16. TORTURE 



Definition 



Deliberately and/or systematically inflicting unusual or 
cruel treatment which results in suffering. 



17. MENTAL INJURY 



Definition 



Injury to the intellectual or psychological capacity of a 
child as evidenced by observable and substantial impairment 
in the child's ability to function within a normal range of 
performance and behavior, with due regard to his/her 
culture. (2) 



18. VENEREAL DISEASE 

Definition: Disease acquired originally as a result of sexual inter- 
course with an individual who is afflicted. The diseases 
are : 

Gonorrhea 

Non-specific Urethritis 

Syphilis 

Chancroid 

Genital Condidiasis 

Lymphorganuloma Venereum 

Granuloma Tnquinake 

Genital Herpes 

Genital Warts 

Balanopostiitis 

Proctitis 

All cases of venereal disease in children under age 21 are 
reported as child abuse. (In Massachusetts, the age is 
under 18). 



19. SEXUAL INTERCOURSE * 

Definition: Sexual union of two individuals, one of whom must be the 

caretaker. It may involve oral, genital or anal sexual 
penetration. Also referred to as coition, coitus and 
copulation. 

* In Massachusetts, this is defined as rape. 



20. SEXUAL EXPLOITATION 

Definition: Unethical or illegal use of a child for the caretaker's 

gratification, advantage, or profit excluding intercourse 
or molestation by the caretaker. 



21. SEXUAL MOLESTATION 

Definition: Contacts or interaction exclusive of sexual intercourse 

between a child and an adult when the child is being used 
as an object of gratification for an adult's sexual needs 
and desires. This may be done by explicitly verbally entic- 
ing, fondling, masturbating, or exposing sexual organs by 
an adult. 



22. OTHER ABUSE 

Definition: Any other physical mistreatment of a child, resulting in 

disfigurement, or loss or impairment of bodily function, 
which is not covered by proceeding definitions. Disfigure- 
ment may be serious, temporary or permanent bodily injuries 
which impair or injure the beauty, symmetry or appearance of 
a person; that which renders unsightly, misshapen or 
imperfect, or deforms in some manned. 



23. LACK OF SUPERVISION/CARETAKER 

Definition: Failure to oversee and manage the child although the care- 
taker is present. 

24. LACK OF SUPERVISION/NO CARETAKER 

Definition: Failure to oversee or to arrange for supervision of a child 



25. ABANDONMENT 

Definition: The legal caretaker's intentional and permanent relinquish- 
ment of caretaking and parenting responsibility, which 
results in the current risk of harm to the child. 

If there is no current risk of harm, the condition should be 
considered as dependency. 

26. INADEQUATE FOOD 

Definition: Failure to provide or have available food adequate to sustain 

normal functioning. It is not as severe as malnutrition or 
failure to thrive which requires a medical diagnosis. 

i 

27. INADEQUATE CLOTHING 

Definition: A child is inadequately clothed if: 

1. the clothing is considerably dirty, torn, too small, or 
too large, worn thin; or 

2. the clothing is not suitable for weather conditions 
such as wearing a cotton t-shirt and sandals to school 
in the winter. 



28. INADEQUATE SHELTER 

Definition: Failure by the parent/caretaker to provide or seek to pro- 
vide shelter which is safe, healthy, and sanitary and which 
protects the children from the elements (weather conditions) 



29. MEDICAL NEGLECT 

Definition: Failure of caretaker to seek medical or dental treatment for 

a health problem or condition which, if untreated, could 
become severe enough to represent a danger to the child. 
Failure of caretaker to follow through on a prescribed 
treatment plan for the child. In addition, failure to 
obtain all necessary immunizations as prescribed by State 
Law 



30. EDUCATIONAL NEGLECT 

Definition: In accordance with State Law, any minor aged seven to six- 
teen, who is not meeting mandated educational requirements 
with the consent, encouragement, or insistence of the 
parent/caretaker. Educational neglect exists only after 
remediation attempts have been undertaken by school 
personnel, including truant officers, court, and school 
social workers, and there is a reason to believe that the 
parent/caretaker is involved. 



31. FAILURE TO THRIVE 

Definition: A serious medical condition most often seen in children 

under one year of age. The child's weight, height, and 
motor development fall significantly short of the average 
growth rates of normal children, i.e., below the 5th per- 
centile. In about 10 percent of these cases, there is an 
organic cause such as serious kidney, heart, or intestinal 
disease, a genetic error of metabolism or brain damage. 
All other cases are a result of disturbed parent-child 
relationships manifested in severe physical and emotional 
neglect of the child. 



32. OTHER NEGLECT 

Definition: Any action or lack of action which results in the failure to 

provide for the child's basic needs and thereby poses a 
potential physical harm to the child (risk of physical 
abuse), which is not covered by the other allegations. 
Potential risks may include: 

exposed wiring (electrocution-lack of supervision) 

animals/rodents (animal bites-lack of supervision) 



APPENDIX C 

PHYSICAL AND MEDICAL INDICATORS 
OF ABUSE AND NEGLECT 



PHYSICAL AND MEDICAL INDICATORS 

* 

OF ABUSE AND NEGLECT 

I. SURFACE SKIN MARKS 

A. Location 

The location of the injury is a significant criterion which can aid iden- 
tification of its origin. Injuries to the thighs, calfs, genitals, buttocks, 
cheeks, earlobes, lips, neck and back are more likely a result of abuse 
than injuries to the elbows, knees, shins and hands, which are frequently 
incurred accidentally. Bruises over the bony parts of the child's body 
(e.g., chin and forehead) are common sites for falling injuries. Bruises 
to any infant should be particularly suspect given his limited mobility and 
opportunity to harm himself. 

B. Objects Causing Skin Marks 

The shape of a surface skin mark or patterns of skin marks provide other 
clues to origin. Bruises which have distinct configurations or which 
resemble instruments should be immediately suspected. Examples of objects 
which cause distinct surface skin marks include: 

° belts, belt buckles, ropes and straps 

° electrical cords 

° hands (palms and fists), feet, knees, and elbows 

mop/broom handles, sticks or other pieces of wood 

° wire or wood coat hangers 

hair brushes and combs 

° cooking utensils (e.b., spatulas) 



• 

This information is adapted from Norman S. Ellerstein, Child Abuse and Neglect , 
A Medical Reference (New York: John Wiley & Sons, 1981): pp. 73-273. 

Richard D. Ruddle, ed . Missouri Child Abuse Investigator's Manual (Columbia, 
Missouri: Juvenile Specialist Program, Institute of Public Safety Education, 
College of Public and Community Services, University Extension Division in 
cooperation with Missouri Council on Criminal Justice, 1981): pp. 41-53. 

Barton Schmidt, in cooperation with the American Academy of Pediatrics, 
University of Colorado Medical Center, The Visual Diagnosis of Non-Accidental 
Trauma and Failure to Thrive (videotape) (Washington, D.C. National Center on 
Child Abuse and Neglect, U.S. Department of Health and Human Services, 1979). 



knives, scissors 

hot liquids 

electric appliances (e.g., irons, heating coils) 

radiators 

lighted cigarettes, matches or lighters 



Marks encircling the child's wrists, ankles or neck may be the result of 
being tied or restrained. Multiple bruises extending out and/or downward 
from the corners of the child's mouth may indicate that he has been gagged 
The child who has been grabbed around the torso by another persons hands, 
may show fingerprints in a pattern that clearly denotes the pressure 
applied — eight finger prints on one side of the torso and two thumbs 
prints on the other side. 



C. Bruises 



Multiple bruises on various parts of the body and in various stages of 
healing should receive particular attention. One way to determine the 
approximate age of a given bruise is by the color. The following lists 
the color of bruises and associated age. 



Age Color 

0-2 days • swollen, tender 

0-5 days red, blue, purple 

5-7 days green 

7-10 days yellow 

10-14 days brown 

2-4 weeks clear 



In addition to color differentiation, injuries incurred at different times 
will reveal older and newer scars. Bilateral eye and facial injuries (both 
eyes or cheeks) are of suspicious origin because only one side of the face 
is usually injured as a result of an accident. The worker should be aware 
that certain birthmarks, in particular "Mongolian spots," can be mistaken 
for bruises. "Mongolian spots" are present at birth and generally last 
until the child is two to three years old. These spots are greyish blue, 
do not change color with time and are commonly located on the buttocks and 
back. Incidence of the discoloration varies for groups of different racial 
descent. The following percentages of babies have Mongolian spots: 95 per- 
cent Chicano babies, and 10 percent Caucasian babies. 



D. Bite Marks 

All bite marks should be suspected as the byproduct of abuse or neglect. 
Although the opinion of a physician or dentist will be needed to firmly 
• identify their origin, workers should be able to make preliminary iden- 
tifications. A bite will be evidenced by a mark the shape of the cutting 
edges of the teeth. It may be seen alone or in conjunction with other 
marks — a suck mark and/or a thrust mark. The such mark ("hickey") is a 
result of the skin being pulled into the mouth by pressure. The thrust 
mark is caused by a tongue pushing against the skin trapped behind and be- 
tween the teeth. Bite marks are egg shaped, are clear or contain the suck 
or thrust mark in the center. 

Human bite marks differ in a number of ways from those of animals (including 
dogs, cats, and rodents), which are the bite marks most commonly seen by 
investigators. In general, animal bites have a narrower arch form (shape) 
than human bites, leave deeper and narrower marks, and tend to have a 
ripping rather than crushing effect. Severe animal bites may resemble 
surgical incisions in some manner. 

Whether human bite marks were inflicted by an adult or child can be determined 
by a trained medical/dental examiner by the size of the impression made by 
the cutting edge of the teeth. Time is an important factor in accurate 
diagnosis of these marks, so workers should immediately secure medical 
opinion for this type of injury. 

E. Mouth Injuries 

Workers may observe the byproducts of trauma to the child's mouth, including 
broken teeth, lip injuries or tears to the frenum (the fold of skin under 
the tongue). The latter may be the result of the forcing of an object (e.g., 
spoon, baby bottle) into an infant's mouth and is generally not coupled 
with other injuries. Although it is possible for a toddler to accidentally 
incur such an injury after beginning to walk, infants less than six months 
old will not incur such accidental injuries. Children between the ages 
of two and five are also not likely to accidentally tear the frenum because 
they move about more steadily and are less inclined to fall into objects 
(e.g., furniture) in a manner that would cause such a tear. Lip injuries 
can be accidental but can also be the result of a forcible blow to this 
area. Deliberate injury through use of an object (e.g., hair brush) should 
be considered. Similarly, teeth may be broken accidentally or as the result 
of a blow to the mouth with an object (e.g., fist, stick). 



II. BURNS 



The extent and characteristics of burn injuries reflect the way the injury 
occureed. For example, cigarette, match tip, or incense burns produce circular 
lesions with blisters and ulcers. A lesion is an injury to the body from 
any cause that results in damage or loss of structure or function of the 
body tissue involved. Old burns are seen as pigmented scars. The palms, 
soles, torso, and buttocks are the most common sites of these burns. 



A. Dry Contact Burns 



Dry contact burns from forced contact with devices/instruments which conduct 
heat (e.g., irons, heating coils, radiators), usually produce second degree 
burns which do not form blisters. The injury resembles the contour and 
shape of the instrument. It is unlikely that an accidental fall against 
one of these objects will cause an injury of this severity because the child 
wouldn't remain in contact with the device for more than an instant. 

B. Scalding 

Scalding burns are a result of dipping a child into hot liquid or pouring 
it over the skin. The burn appears uniform in those areas which were 
exposed to the hot substance with a line separating the burned area from 
the unburned skin. " Stocking " burns refer to the injury that results when 
the child's feet are submerged in a hot liquid. " Glove " burns are caused 
when the child's hands are forcibly submerged in a hot liquid. Another 
type is a " dunking " burn, in which the scalding injury is to the feet, 
buttocks and perineum (i.e., the area between the anus and the posterior 
part of the external gentialia) corresponding to the child's posture during 
submersion. Splash marks are not evident because the child's movement has 
been constrained. On occasion, an area of skin within a submersion burn 
will show no injury. This can happen when the submerged part of the child's 
body is pressed against the bottom or side of the container (e.g., tub). 
These burns are often associated with discipline for "accidents" during 
toilet training. Because this area is not exposed to the hot liquid for the 
same period of time, the degree of injury will differ. Exposure to liquid 
of varying temperatures for different lengths of time affects the type of 
injury incurred. For example, prolonged exposure to bath water (105-110°) 
will not cause burns, while exposure to 158° water, even for one second, 
will produce third-degree burns. Burns are usually classified as: 

° First Degree - Superficial burns, damage being limited to the outer 
layer of the skin. 

° Second Degree - The damage extends through the outer layer of the skin 
into the inner layers. Blistering will be present within 24 hours. 

Third Degree - Burns in which the skin is destroyed with damage extending 
into underlying tissues, which may be charred or coagulated. 

III. HEAD INJURIES 

Violent pulling of the child's hair may cause bleeding under the skin surface, 
swelling of the scalp, and the simultaneous loss of hair resulting in bald spots 
or patches. 

Subdural hematoma , bleeding between the brain and the skull, is caused when tie 
vein bridging the two is torn. This injury can result from a fall, a direct 
blow to the head, or violent shaking. Although medical exams and x-rays are 
needed to detect all symptoms, the presence of swelling and bruises to the 
scalp, bleeding of the eye, vomiting, seizures or a coma/loss of consciousness 
should alert the worker to the possibility of this injury. Finger-tip encircle- 
ment bruises around the torso, or bruises to the skin located over the center 
of the shoulder bone (back) and the center of the collar bones (both sides) and 
the absence of a skull fracture with the above listed symptoms may indicate that 
the harm resulted from violent shaking. 



IV. INTERNAL INJURIES 

Blows (e.g., punches, kicks) to the child's chest or abdomen may cause internal 
injuries. Diagnosis of these injuries will require medical examination but can 
sometimes be detected by the worker. Tenderness or swelling of the skin or 
vomiting may signal the presence of these injuries. The child with internal 
injuries may appear pale, have an anxious expression, be cold, perspiring 
freely, and semicomatose. The child may report having experienced intense pain 
which may diminish over time. 

A variety of fractures can result from trauma to the child's bones. Medical and 
x-ray examinations are necessary to diagnose these injuries. Observable symp- 
toms include swelling, the child's inability to move a limb, or protrusion of 
the bone(s) through the skin surface. 

There are ten types of fractures, the most common being: 

o Simple — the bone is broken, but there is no external wound. 

o Compound — the bone is broken, and there is an external wound leading 
down to the site of fracture, or fragments of bone protrude through 
the skin. 

o Complicated — the bone is broken and has injured some internal organ, 
such as a broken rib piercing a lung. 

o Comminuted — the bone is broken or splintered into pieces. 

o Spiral — twisting causes the line of the fracture to encircle the bone 
in the form of a spiral. 

Skeletal injuries that may indicate abuse include: 

o Spiral fractures — fractures that wrap or twist around the bone shaft. 

o Corner fractures of long bones/metaphyseal — splintering at the end of 
the bone. 

o Epiphseal separation — a separation of the growth center at the end of 
the bone from the rest of the shaft, and periosteal elevation — a 
detachment of the periosternum (i.e., surface layer of the bone/membrane 
of connective tissue) from the shaft of the bone with associated bleeding. 
These injuries are caused by twisting or pulling. 

V. SEXUAL ABUSE 

Physical evidence of trauma in children who have been sexually abused is present 
in only a small percentage of cases. The worker may detect the possibility of 
this abuse from the child's statements, or from a number of observable symptoms, 
including the child's difficulty in walking or sitting; reports of pain or 
itching in the genital area; and bruises, tearing, swelling or bleeding of the 
external genitalia, vaginal, and/or anal areas. Infections of the vagina and 
lower urinary tract, venereal disease in pre-pubescent children, the presence of 
sperm in the rectum, vagina or vulva/perineum, or on the child's clothing, and 
pregnancy are indications of possible sexual abuse. A physical examination by 
trained medical personnel may be indicated, following disclosure, to rule out 
bodily injurv infection, or pregnancy. 



In addition to the physical indicators, workers must be prepared to identify 
behavior and statements that signal sexual abuse. All statements of the child, 
caretaker and other family/household members that suggest the possibility of 
sexual abuse must be taken seriously. In particular the worker should not be 
sidetracked if the child has made statements alleging sexual abuse and sub- 
sequently retracts them. This retraction may result from the child's awareness 
of the implications and repercussions of her acknowledgment. As a comparison, a 
child who has fabricated sexual abuse allegations in order to punish or get even 
with the caretaker may be less likely to retract her statements than the 
child who is upset with negative repercussions of her acknowledgment and who 
reverses her position in an attempt to return life to normal. 

The child's behavior may provide additional cues to the existence of sexual 
abuse. For example, a four-year-old who possesses a high level of information 
and awareness about sexual relationships and/or engages in play which graphi- 
cally simulates intercourse may have obtained this information from sexual abuse. 

The worker should never disregard such sophistication by dismissing it as fan- 
tasizing or acting out what has been seen on television. Additional investiga- 
tion is warranted. Other symptoms include sexual acting out, school problems or 
other "soft" signs of emotional dysfunction. When the worker has the least 
suspicion of sexual abuse, he should immediately take the child to a physician 
or emergency room. 

VI. POISONING 

A child may be accidentally or intentionally poisoned following the ingestion, 
inhalation, injection or absorption of substances which interfere with the 
body's normal physiological functions. In addition to dangerous chemicals 
(e.g., cleaning fluids), almost all substances can be poisonous if consumed in 
sufficient quantity. An excessive dosage of even common subtances, such as 
aspirin, can be poisonous. A medical opinion is needed to confirm this 
diagnosis . 

VII. PHYSICAL NEGLECT 

Physical neglect results when the caretaker fails to provide for the child's 
basic physical needs and manifests itself in a number of ways. 

o Failure-to-thrive syndrome — The child's weight, height and motor developaen 
fall significantly below the average growth rate of normal children (i.e., 
below the 5th percentile). The child appears malnourished, with a noti- 
ceable absence of fatty tissue, and has hair loss or thin, short hair. 
The presence of a large bald spot on the back of the child's head may 
signal that the child is not picked up enough. The child may not respond 
to cuddling, may not engage in eye contact and may have an expressionless 
face. In about 10 percent of the cases there is an organic cause. In 90 
percent of cases it is due to emotional deprivation and the withholding 
of food. 

o Nutritional deprivation (malnutrition) — A child who lacks sufficient 

quantity or quality of food may suffer developmental lags and incur 

medical problems. In the most serious form of this problem, the child 
can starve to death. 



o Inadequate hygiene — A child who is inadequately bathed may have repeated 
skin infections or other persistent skin disorders. Severe diaper rash as 
well as the chronic presence of dirt or feces on the child's skin, under 
the nails, or on clothing may also indicate inadequate hygiene. 

o Inadequate clothing — A child who is indequately clothed regularly wears 
dirty, torn, ill-fitting, ragged, or thin clothing unsuitable for weather 
conditions and may be subject to frostbit /exposure , to infestation or to 
ridicule because of the condition of the clothing. 

o Medical neglect — A child who does not receive needed medical or dental 
care, including medication may develop a health problem, or a preexisting 
health problem may be aggravated. 

o Abandonment — A child left totally unsupervised for a long period of time 
or who is left with a neighbor or relative and whose caretaker fails to 
return to pick up the child is considered abandoned. 

o Lack of supervision — A child left unattended, or in the care of other 
children too young to protect him from harm, or who is inadequately super- 
vised for long periods of time or when engaged in dangerous activities is 
considered lacking supervision. 



APPENDIX D 
BEHAVIORAL INDICATORS OF CHILD ABUSE 



BEHAVIORAL INDICATORS OF CHILD ABUSE 



Children who are abused physically or emotionally display certain types of 
behavior. Many of these are common to all children at one time or another, but 
when they are present in sufficient number and strength to characterize a 
child's overall manner, they may indicate abuse. More than simple reactions to 
abuse itself, these behaviors reflect the child's response to the dynamics of 
the family. Children learn to deny, suppress or exaggerate parts of themselves 
as they struggle to get their needs met the best way they can in a disturbed, 
stressful household. These learned survival mechanisms become a child's "mode 
of operation" used to cope with the world at large. The behaviors which 
characterize abused children fall into four categories: 

Overly compliant, passive, undemanding behaviors aimed at maintaining a low 
profile, avoiding any possible confrontation with a parent which could lead to 
abuse. The child has adapted to the abusive situation by trying to avoid any 
behavior which the abusive parent notices at all. 

Extremely aggressive, demanding and rageful behaviors, sometimes hyperactive, 
caused by the child's repeated frustrations at not getting basic needs met. The 
child has adapted by seeking to provoke the needed attention with whatever beha- 
vior it takes to get the attention. 

Role-reversed "parental" behavior, or extremely dependent behavior. Abusive 
parents have been unable to satisfy certain of their own needs appropriately and 
so turn to their children for fulfillment, which can produce two opposite sets 
of behavior in the children. If a parent needs parental attention, the child 
may be expected to assume this task, and become inappropriately adult and 
responsible. Other parents, with a need to keep their child dependent, will 
produce clinging, babyish behavior in the child long after a child in a healthy 
family would become more self-reliant. 

Lags in development. Children who are forced to siphon off energy, normally 
channeled towards growth, into protecting themselves from abusive parents, may 
fall behind the norm for their age in toilet training, motor skills, socializa- 
tion and language development. Developmental lags may also be the result of 
central nervous system damage caused by physical abuse, medical or nutritional 
neglect or inadequate stimulation. There may, of course, be organic or con- 
genital causes for such lags in development. 

Most abused children live in uncertain environments where requirements for 
behavior are inconsistent and unclear. Frequently, discipline is meted out 
arbitrarily in response to the parent's needs and feelings at the moment rather 
than to punish a child for transgressing limits. Children may receive some 
love, affection and security from their parents, but are also often frustrated 
in attempts to fulfill their needs. This inconsistency creates anger and 
frustration in the child, which is frequently expressed indirectly with the 
parents or by explosions with others outside the home. 

Other abused children have learned to do what the abusive parent wants or 
expects. At the other end of the spectrum from overly aggressive children 
some adapt quickly to others' expectations. Unlike children who act out 
their frustration and rage, these children have learned not to expect anything 
in the way of love or support. Their best efforts are directed at avoiding 
conflict which, in the context of the abusive family, can be triggered by 
expressing almost any personal need, curiosity, anger, or playfulness. 



Ultimately, a list of specific behaviors to identify child abuse is useful only 
if the family dynamics that produce those behaviors are clearly understood. 
The behaviors, verbal and physical, indicate both the survival techniques the 
child has learned in order to exist in the family and attempts - frequently 
inappropriate in kind or intensity - to get from others what the parents do 
not provide. The greater the abuse, the less the child will trust other people 
and the greater the child's difficulty in responding to love and care. 



from the National Center for Child Abuse and Neglect Specialized Training 



APPENDIX E 
DEVELOPMENTAL MILESTONES OF CHILDREN 






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